High-deductible health plans are supposed to encourage consumers to shop around for cheaper health care services or put money away to pay for what they need. But it's not working that way, according to a new study published in JAMA Internal Medicine by a team from the University of Michigan Institute for Healthcare Policy and Innovation.

An Insurance Journal report says that even though such plans are becoming more common, workers with high-deductible health plans aren’t taking any of the actions one might expect them to take—from actually putting money into an HDHP savings account to checking for the best prices to trying to negotiate better rates, or even just talking to their doctors about costs. And even when they do, they’re not getting the help they need.

“Most Americans in HDHPs are not doing things that can help them get the care they need at the lowest possible cost, and even those who are doing so could realize more benefits,” Jeffrey Kullgren, M.D., M.S., M.P.H., an assistant professor of general medicine at U-M and lead author of the study, says in the report.

According to the Centers for Disease Control and Prevention, more than 40 percent of American adults have an HDHP. Such plans require individuals to pay at least the first $1,300 of their own costs and families the first $2,600, and are usually offered with a tax-protected health savings account aimed at providing a place for people to save for future health care expenses.

But they’re not working that way. Even though their advocates say that such plans are a way to give patients “skin in the game” and make them play a more active role in keeping costs down for their own care, researchers say that many people aren’t pursuing “consumer” behaviors such as saving, negotiating costs with providers and researching quality ratings—even among patients with chronic health conditions.

And the disconnects are pretty big. For instance, overall, 58 percent of poll participants said they had an account to put aside money for medical expenses, including HSAs. But only 40 percent of the entire sample had actually saved any money in those accounts. Just 25 percent had talked to a healthcare provider about the cost of a service, and a scant 14 percent had compared prices for the same service or product, or the quality ratings for different providers.

Fewest of all were the brave souls who tried to bargain on prices; only 6 percent had tried to negotiate the price of a health care service, either in advance or after they received a bill for a service they’d received.

Even more discouraging, just 45 percent of those who had compared prices said it had actually helped them pay less for a service. Among those who had talked to a provider about cost, two-thirds had done it for prescription medicines, but only 45 percent said that having done so had helped them get care they needed.

In the report, Kullgren notes that other research indicates that people in HDHPs often use less health care than people with other types of insurance. But—and it’s a big but—they also use less of the care that might be most effective for them, as well as less-effective care that they probably don’t need.

The researchers conclude that health care providers, insurers and employers could do more to help people in HDHPs, such as providers helping patients to understand possible future needs for which they should save; health care facilities making prices available at the point of care so that patients and providers can talk about cost; and employers offering HDHPs providing more than just price information so that employees learn how to use this information when making decisions.

Instant Insights /

More 'skin in the game' doesn't make HDHP consumers any savvier

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