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SALT LAKE CITY — As the number of Americans with high-deductible health insurance plans has jumped significantly in recent years, most enrollees have not adapted their consumer habits to control out-of-pocket costs, according to a new study out of the University of Utah.
"I think some of it (is), I think they don't know how to do it. We've been trained to negotiate with car dealers. That's just what you do. Nobody ever thinks about negotiating with a provider," Angie Fagerlin, chairwoman of the Department of Population Health Sciences at the U. and senior author of the paper, told KSL. "It's just not perceived as normal."
The Centers for Disease Control and Prevention says 40.6 percent of Americans under 65 with private insurance had a high-deductible plan in 2016, compared to 29.5 percent in 2011, with most of that increase coming among people who receive coverage from an insurer.
The agency's definition of high deductible, which was also used by the U., is at least $1,300 for individual health costs or at least $2,600 for family health costs, meaning care received before reaching that threshold is generally paid for out of pocket.
"Most Americans who have them aren't saving, shopping around for better prices, talking to their doctors about costs or making other consumer-type moves," University of Utah Health science writer Julie Kiefer said in a release.
Fagerlin, who is also a researcher at the Veterans Affairs Medical Center in Salt Lake City, oversaw the creation and carrying out of a survey in August and September 2016 that asked about the consumer habits of 1,637 Americans between the ages of 18 and 64 who were on private, high-deductible health plans.
Fagerlin began the project while working at the University of Michigan, but completed it after being hired at the U. The results were published last week in JAMA Internal Medicine, a peer-reviewed academic journal.
Among respondents, 14 percent said they had compared different prices — or the quality ratings of various providers — before getting a medical product or service. Six percent said they attempted to negotiate the price of a medical service either before or after they were billed, and 25 percent said they had a conversation with a health care provider about the cost of a service.
Fagerlin believes that despite health care costs being comparable to other expensive purchases that are considered negotiable, patients are led to believe prices for medical treatment are set in stone.
"I just think we don't have the training and don't know it's a possibility, and also (people) don't want to (feel) embarrassed in front of their physician," she said.
Among respondents who did have a conversation with their provider about the price of a service or prescription, 45 percent reported it was beneficial to them. Among those who compared prices between providers, an identical proportion of them — 45 percent — felt it saved them money.
"Even people who tried, about half of them didn't think it was worth it and helpful," Fagerlin said. "We don't know why or what happened or what made it not be helpful."
She noted examining that question could be a good goal for future research.
Additionally, 58 percent of respondents reported having an account to put money specifically for medical costs, such as a tax-advantaged Health Savings Account, though just 40 percent said they had any funds put aside for future medical needs.
Some employers contribute to their workers' Health Savings Accounts, which are not subject to federal income tax and can only be used by enrollees in high-deductible plans.
In 2016, about 15.5 percent of all people with a private high-deductible health plan had "problems paying medical bills in the past 12 months," compared to 10.3 percent who experienced the same issue on a traditional plan, according to the Centers for Disease Control and Prevention
Fagerlin said there is a significant discussion to be had about who can help enrollees in high-deductible plans to both save money for out-of-pocket costs and navigate their pre-deductible spending.
"Do we do it on a provider side, do we do it on a (health) system side, do we do it on a patient side?" Fagerlin mused. "How should it work?"
She said it's clear that "it shouldn't all be on the patients." Insurers "need to be better at getting that information to people, too," she added.
Fagerlin also believes employers have the ability to make a big difference through relatively simple messaging campaigns aimed at connecting workers with online price comparison tools, encouraging them to research providers' costs and promoting other money-saving strategies.
"It ... benefits them if their employees are well-cared for and less stressed out," she said.
Kiefer also wrote that physicians can help patients "understand their possible future medical needs so they can try to save for them" and that "health care facilities could make prices available at the point of care so that patients and providers can talk about cost."