Will consumers make more cost-effective choices of health services and doctors if 
they are spending their own money? Common sense suggests they would, but researchers have found that consumers don’t always make health care decisions that way.
The study was based on a survey of nearly 2,000 Americans who had recently purchased medical services were asked what factors they consider when choosing a doctor or medical service. About half of those surveyed had high-deductible health plans, in which the consumer is responsible for substantial out-of-pocket expenses, while the rest had more traditional plans.
Even when people were responsible for a bigger portion of their health costs, the researchers found, they were not more likely to consider cost or shop around for the best deal on medical treatments.
The results were reported in a research letter published in the medical journal JAMA Internal Medicine.
A majority of the people surveyed knew that some doctors cost more than others. But even with that knowledge, only about 10% of consumers considered changing doctors the last time they bought medical care, and only about 4% compared costs. This was equally true for those with high-deductible plans and for those with traditional plans.
Slightly more than half (56%) of those with high-deductible plans said they would use additional sources of health care pricing information if they were available. So did about half of those with conventional coverage.
Although “there is a big incentive for consumers in high-deductible health plans to price shop,” said Neeraj Sood, Ph.D., a co-author of the research letter, “they just don’t seem to be doing it.”
Dr. Sood is director of research at the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California.
A Kaiser Family Foundation survey of employer health benefits found that there has been an upturn in the use of high-deductible health plans. Almost 25% of people with employer-based coverage had high-deductible plans in 2015, almost double the 13% just five years earlier.
While THE trend toward higher deductibles accelerates, says Dr. Sood, consumers still find it difficult to comparison shop, because the health care industry does not make pricing information readily available and there are few decision tools to help consumers make the right choices.
Complicating such decision-making by consumers is the fact that when people buy a medical procedure, they are often paying for several services at the same time. For example, an operation might result in payments for the surgeon, the anesthesiologist and the hospital fee. This kind of bundling together of several services makes it harder to price shop.
The JAMA report is the most recent effort to measure the impact of high-deductible plans on consumer behavior. Previous studies have also found that high-deductible plans don’t directly translate into more comparison shopping by patients, or more efficient users of health care.
In October, the National Bureau of Economic Research (NBER) published a paper analyzing how people’s behavior changed when their employer switched coverage from a free health plan to one with a high deductible.
The NBER study found that the switch did not cause workers to look for better prices when buying health care. Instead, the employees used less health care, cutting back not only on things they might not need, like imaging scans, but also on important services like preventive checkups.
