As health care costs increase, consumers are being asked to manage more of their own health care spending.  One of the most common ways this is happening is through high deductible health insurance plans.

Several years ago, my wife and I signed up for a high deductible health plan.  It was a new offering from our employer and as two physicians we figured we were in a pretty good position to navigate the health care system.

One of our first unexpected expenses arose after our daughter fell on the playground at school and broke her wrist.  We didn't know it was broken after she fell but we knew she quickly needed an x-ray.

We thought we were being savvy consumers – rather than going to an emergency room, we managed to get our pediatrician to arrange for an x-ray at a nearby facility.   We thought we were on the right track.  X-rays are cheap. ER visits are expensive.

Several weeks later, I received an "explanation of benefits" from our health insurer –the price for that simple x-ray was almost $500.  I then discovered our health insurer has a price shopping website.  That $500 x-ray was well under $100 at many other facilities.  So while we thought staying out of the emergency room would insulate us from high prices for a very simple test, we still got hit with a high charge by choosing the wrong facility.

The whole premise of high deductible health plans is to give consumers "skin in the game" so they shop around, choose cheaper providers, and don't use care they don't need.  The idea of shopping around can be a good thing but in practice hard to do. I just returned from a health policy conference where the results on price shopping tools were pretty clear – hardly any consumers use them.  Just 1.3% of members of a large health plan used the tool.  Why might that be?  One expert speculated that because health care is something consumers use relatively infrequently, it is harder to turn this into a habit.  And since you need to login to these proprietary shopping tools, they are hard to access.

I think another reason is that patients rely a great deal on their doctors to help them choose.  Our research team recently interviewed patients diagnosed with prostate cancer to find out how they went about choosing specialists.  Nearly all of them relied on their primary care doctor.  When I looked up orthopedic specialists for our daughter's broken wrist on our health insurers' shopping tool – I got dozens of choices but no good information to actually make a choice.  When you have lots of choices, decisions are overwhelming.  When you have lots of choices and little information, good decisions are impossible.  Price alone is just not enough information.

I think insurers selling high deductible health plans need to prioritize renegotiating these outlier prices.  Asking consumers to navigate these irrational prices on their own leads to struggle and financial pain for families.  Why do insurers tolerate one provider charging 5-10 times other providers? Of course some providers will be more expensive than others but there is no good explanation for this amount of price variation for a low-tech medical test.

For any method of price shopping to work, I think price information needs to be part of visits with doctors.  Patients rely on doctors to refer them to certain providers and places.  Shopping around may even feel like going against your doctor's advice.  The moment referrals are being made seems like the right time to make this information available so it can be part of a discussion with your doctor.  Right now, price information is rarely available to doctors.  That is a problem worth fixing.

All of the discussion about high deductibles is based on the premise that consumers can and should shop and that high cost providers will over time lower their prices to attract patients.  The problem with this logic right now is that a lot of cost sharing seems to just lead to consumers using less of everything – even the important things. It's hard for consumers to wade through differences in price, quality and ultimately value.

Our family was able to absorb this unexpected expense.  A financial shock of this size for many families can lead to real struggles.  So this is not just a problem worth fixing because the nation needs to lower health spending – it is a problem worth fixing so that patients aren't unnecessarily harmed by high prices.


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