A widely reported study last fall, summarized below in a Vox article, found that high deductible plans do not lead to cost shopping, but to lower utilization of medical services.
The researchers had a particularly fortunate natural testing pool. A corporation changed from a Cadillac plan to a high deductible plan, and deposited 3750, the amount of the deductible, into a Health Savings account for each employee. Economically, the fact that a formerly fully covered service would have a visible cost should have had no effect on behavior. (The article does not state whether the company provided a medical credit card that would draw from the HSA account – I suspect that cash outlay was required followed by reimbursement.) However, people reduced costs by simply not going to the doctor at all, even those with chronic conditions who would easily blow through the deductible quickly and re-enter the fully covered stage early in the year.
I personally noted a change in my behavior – when I have to pony up the “full” health plan reduced cost (I never reach the deductible) for something, I don’t bother to consult the doctor and just use Dr Google and non-prescription remedies. I can certainly afford it – I have a self-funded HSA with a Visa attached. But it just seems wasteful to spend 150 just to be told to put liniment on an aching joint. I used to go to the company nurse for minor complaints when it was free or to the HMO when it was just a small co pay. Last fall I could not shake a cold/bronchitis so I spent the money and went twice. (She finally suggested a Neti Pot. One look at it and the how to video and I was “healed.”) In Sept I start with Medicare advantage and I assume my behavior will change back to my old habits.
For those of you with high deductible plans, do you comparison shop or forgo non-emergency visits? For those who don’t have high deductible plans, is that a conscious choice because of actual usage, or perhaps because of the psychological issue described above?