‘Skin in the Game’ Doesn’t Make Patients Better Health-Care Shoppers: Study
Health Care

‘Skin in the Game’ Doesn’t Make Patients Better Health-Care Shoppers: Study


Proponents of high-deductible insurance plans argue they make consumers better health-care shoppers. The idea is that asking patients to cover more of their health care costs — to have “skin in the game” — will lead them to make more prudent, cost-conscious decisions about their care.

Only it doesn’t work, according to a new study published in Health Affairs. The latest study adds to previous evidence that consumers don’t shop around for the best health care value, even when they’re spending their own money. And concerns have grown that patients with high-deductible plans end up delaying or forgoing care they can’t afford.

The new Health Affairs report details the results of a survey of 1,637 Americans in high-deductible health plans. It found that:

  • Just one in four enrollees in high-deductible plans had talked to a health-care provider about how much a service would cost.
  • Less than 15 percent compared prices across multiple locations.
  • Less than 15 percent compared quality measures for a service at different locations.
  • Just 6.5 percent tried to negotiate a price with their provider.

The most common reason people didn’t try these “consumer behaviors” is that the idea never crossed their mind. Nearly a third of those surveyed hadn’t considered discussing costs with their provider, for example (and a similar percentage said such a discussion wouldn’t have changed their decision about care). Forty-four percent of those surveyed said they hadn’t thought to compare prices — and nearly 40 percent said that comparing prices wouldn’t have changed their care choices.

Why it matters: “These results raise important questions about the extent to which patients in HDHPs are willing and able to function as consumers in the health care marketplace,” the report’s authors write. But they also say that the survey results indicate there may still be room for employers, insurers and providers to better promote “consumer behaviors.”

Read more of Health Affairs’ March issue on patients as consumers, including this blog post on the ‘new’ health care consumerism and this commentary piece on why patients shouldn’t be viewed as consumers.