Price comparison More HDHPenrollees report searching for cost information than traditionalplan enrollees, but a higher percentage of traditional planenrollees report actually finding information when they search forit. (Photo: Shutterstock)

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A new survey suggests that high deductible health plans (HDHPs) can be agood news/bad news proposition: although they succeed in makingplan enrollees better-informed consumers, they also areassociated with negative outcomes such as delaying care because ofcost concerns.

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The survey, conducted by Employee Benefit Research Institute(EBRI) and Greenwald & Associates, is an annual study ofconsumer attitudes. Now in its 14th year, the latest study surveyed more than 2,000 adults,85 percent of whom are enrolled in employer-based health plans.

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Related: 10 states where consumers are more likely to skipthe doctor due to cost

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The research is increasingly relevant due to the fact that thenumber of Americans enrolled in HDHPs continues to rise. The study notes that between2007 and 2018, the percentage of individuals under age 65 enrolledin high-deductible health plans increased from 17.4 percent to 46percent, a 264 percent increase.

More likely to search for information, but…

One good news/bad news aspect of the EBRI report is its “engagedconsumers” findings. HDHPs have long been seen as a way to helpconsumers become smarter shoppers when it comes to health caredecision-making. By giving consumers more skin in the game throughhigher deductibles, these plans sought to encourage enrollees to domore research and cost-comparison.

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And the survey found HDHP enrollees doing just that. “More thanone-third (39 percent) of HDHP enrollees versus 25 percent oftraditional plan enrollees tried to find cost information in thelast two years before receiving care,” the report says.

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However, the results of those efforts were somewhat mixed: moreHDHP enrollees report searching for cost information thantraditional plan enrollees, but the study shows a higher percentageof traditional plan enrollees report actually finding informationwhen they search for it.

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The complexities of finding cost information may be affectingthese results; it's possible that HDHP enrollees are more likely tosearch for harder-to-find information.

Informed consumers

Across the board, the HDHP enrollees showed more cost-consciousbehavior. They were more likely than those with traditionalcoverage to say that they had checked whether their plan wouldcover care or medication; they were more likely to check thequality rating of a doctor or hospital before receiving care; theymore often asked for a generic instead of a brand name drug ortalked to their providers about options; and they were more likelyto use an online cost-tracking tool provided by the healthplan.

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HDHP enrollees were also more likely than traditional planenrollees to report that their employer offered them biometricscreenings, financial wellness resources, and reimbursement for allor part of fitness memberships. But HDHP enrollees did notuniversally exhibit better health behaviors in this area. “Whilethey were more likely to be offered reimbursement for fitness clubmembership, just over a quarter of [HDHP enrollees] participated insuch available programs, compared to 42 percent of traditionalhealth care plan enrollees.”

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The study also noted that HDHP participants showedcost-consciousness in another way: “HDHP enrollees were more likelythan traditional plan enrollees to note that their health insurancepremiums would have been higher had they not participated in theemployer's wellness program,” the study says.

Delaying care, worrying about finances

The EBRI study found that the biggest difference incost-conscious behavior is that HDHP enrollees were nearly twice aslikely to report that they had delayed medical care because ofcost. “One-third of HDHP enrollees reported delaying care, whereas18 percent of traditional plan enrollees delayed care because ofcosts,” the study notes.

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The study also found an interesting pair of facts: even thoughHDHP enrollees tended to have higher income than traditional planenrollees, they also were more likely to report they had majorfinancial concerns.

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The mixed messages coming from the survey, the authorsconcluded, may influence decision making by employers. “Concernsover the financial well-being of workers may be what's holdingemployers back from adopting HDHPs more broadly,” they write.

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