High-Deductible Health Plans Enrollees No More Likely to "Shop Around"

Having a high-deductible healthcare plan (HDHP), which some policymakers believe gives enrollees “skin in the game,” appears insufficient to facilitate price shopping, a recent study concluded.

Neeraj Sood, PhD, of the University of Southern California, and colleagues surveyed a nationally representative sample of insured US adults who used medical care in the last year to compare HDHP enrollees with enrollees in traditional plans on rates of whether they “shop around” for healthcare to compare out-of-pocket costs. The article was published as a Research Letter in JAMA Internal Medicine.

The study included 1951 respondents (1099 HDHP and 852 non-HDHP enrollees). Enrollment in HDHP was higher among white patients, employed individuals, and those with higher education and higher incomes. HDHPs were defined as health plans having an individual deductible greater than $1250 or a family deductible greater than $2500 or a health plan that included a health savings account.

During their last use of medical care, HDHP enrollees were no more likely than traditional plan enrollees to consider going to another healthcare provider for care (11% vs 10%) or to compare out-of-pocket cost differences across healthcare providers (4% vs 3%), the study found. Most HDHP enrollees (60%) believe there are large differences in prices and quality (68%) across healthcare providers; 17% think higher-priced physicians provide better quality care, and 71% report that out-of-pocket costs are an important consideration when choosing a physician—all viewpoints not significantly different than those held by traditional-plan enrollees.

The study’s findings are limited by recall bias and the fact that it did not survey uninsured people or enrollees who did not use medical care.

The study authors conclude that simply increasing a deductible appears insufficient to facilitate price shopping. They found that members of HDHPs and traditional plans are equally likely to price shop for medical care, and they hold similar attitudes about healthcare prices and quality.

“Despite considerable focus on increasing price transparency, HDHP enrollees express interest in greater access to healthcare price information,” the authors wrote. “If encouraging price shopping is viewed as an important policy goal, then there is a need for greater availability of price information and innovative approaches to enrollee engagement with this information.”