Health economist Jane Sarasohn-Kahn writes:
“The theory behind ‘consumer-driven health care’ is that when the health care user has more financial ‘skin in the game,’ they’ll become more informed and effective purchasers of health care for themselves and their families. That theory hasn’t translated into practice, based on data from the Employee Benefits Research Institute’s (EBRI) latest Consumer Engagement in Health Care Survey.”
Her “hot points” summary:
“Over the past decade, employee benefits consultants and certain health policy theorists have pointed to consumer-driven health care (CDH) delivered through healthcare reimbursement accounts as an effective vehicle for bending the cost curve of health in the U.S. EBRI’s data should give CDH proponents pause. Consumers don’t behave in straight-line, lock-step fashion when it comes to health care consumption: the general rules of Economics 101 don’t apply for a whole range of reasons I and many other economists have discussed.
Don’t assume that consumers having more financial skin in the health care game will make them smarter health consumers. Many health citizens make what seem to be smart fiscal decisions for health care consumption in the short run — like postponing visits to doctors when they feel ill, or skipping doses of medication. These often lead to longer-term dismal physical outcomes.”
But she doesn’t address the assumption that consumer-driven health care plans will provide consumers with the information tools they need to make better choices – a point addressed by one commenter in reaction to her piece on the The Health Care Blog:
“To understand the impact that consumer driven healthcare can have you need to understand the openness of the health care system. Currently the information available to health care consumers is not complete. I have a high deductible health plan and an HSA. It is very difficult to compare prices between providers. Additionally information regarding success rates and effectiveness of service providers is difficult to obtain. When care is needed urgently there is not time to perform this analysis. In contract, if you want to buy a TV or almost any other item, volumes of information is readily available. Consumers can easily find retail prices, sale prices, expert reviews, consumer reviews, and product details. The information informs the decision making process and, as a result consumers (usually) make better decisions. Providers are forced to compete with each other in the open. This competition brings about lower prices and higher quality as the lower quality/higher priced providers will lose market share to their competition. Only when the health care market reaches this level of openness will you be able to gauge the effectiveness of consumer directed healthcare.”