U.S. health policy leaders are desperate. Despite innumerable studies, policy proposals and conferences, population health statistics continue to decline while health care costs continue to rise. Not an impressive result for all of that analysis!
One of the leading magic bullets proposed for the health system has been "consumer directed health care." The core idea is that if high deductibles put patients at risk for more of the cost of their care they will become (a) more active in promoting their own health and (b) more discerning "consumers" of health care. These are clearly desirable outcomes.
We know that "consumer directed health care" achieves two desirable outcomes. The cost to employers is reduced and the premium cost to individual enrollees is less than their cost would be for insurance without the deductibles. But what about the impact of deductibles on patients. Do they become more active in promoting their own health and sizing up the value of proposed health interventions?
A study from the University of Oregon published in American Journal of Managed Care suggests that the answer is - no.
The researchers surveyed 1616 employees at the start of their enrollment in plans with and without high deductibles and a year later. The key finding was that patients who were higher on a measure of "activation" (knowledge, skill, and confidence in managing one's own health and health care) became more active over the course of a year regardless of whether they were or were not in a "consumer directed health plan." Enrollment in a high deductible plan, however, did not prod patients to become more active.
In other words, in this group of insurees, the magic bullet of "skin in the game" did not transform otherwise passive patients into active "consumers" and self-managers.
Another article in the same issue studied a different approach to change. Instead of prodding patients with financial risk, on the assumption that they lacked "skin in the game," patients were treated as partners, and given the same information about clinical guidelines that their physicians received. Simply providing patients with clinically relevant information increased adherence to evidence based guidelines by 12/5%.
Wise clinicians will not be surprised by these findings. Health has intrinsic worth. It isn't a consumer item that requires financial penalties to make us care about it. Providing patients and clinicians with the same information at the same time is like well-timed therapy for a couple. It points in directions both want to go in.
Two studies aren't definitive, but they suggest a direction that builds on the core values of physicians and their patients. That seems promising!