Consumerism, Price Transparency, and High-deductible Health Plans

Historically, it has been difficult or impossible for patients to price shop for health care, i.e., comparing prices for health care services across providers. Price transparency – whereby consumers are given access to price information for health care services – seeks to break that information barrier. Many employers, insurers, and states have implemented new programs to make prices more easily accessible. Increasing price transparency was one of President Trump’s five recommendations for national health care reform.

A number of factors have made price transparency and price shopping more important. First, there is growing evidence that there is substantial price variation across providers within health care markets, and that this variation is not systematically associated with quality. If consumers selectively seek care from lower priced health care providers, then this could potentially decrease health care spending without any ill effects on health. Second, roughly half of all people with employer-based insurance have a high-deductible insurance plan. Given the increased cost that employees face, employers feel a corresponding responsibility to give patients tools that will better help them manage their spending. The hope is that price transparency will help patients have more control of their health care spending and feel empowered in their decision making. Lastly, many patients are frustrated by “surprise bills” and want the tools to help avoid such unexpected costs.

In our prior research, we have addressed a number of related questions:

  • Do patients use quality data to choose their providers?
  • What is the impact of high-deductible health plans on spending?
  • Do high-deductible health plans encourage price shopping?
  • Does offering a price transparency tool facilitate shopping for care and reductions in spending?
  • Who uses price transparency tools?
  • How often do Americans shop for care and what are the barriers to price shopping?
  • Would patients truly save money by choosing a low-cost primary care physician?

These ideas have been addressed across a series of research studies:

  • Whaley C, Sood S, Michael Chernew ME, Vu L, Metcalfe L, Mehrotra A. Paying Patients to Switch: Impact of a Rewards Program on Choice of Providers, Prices, and Utilization Health Aff (Millwood). 2019 Mar;38(3):440-447.
  • Gourevitch RA, Mehrotra A, Galvin G, Plough AC, Shah NT. Does comparing cesarean delivery rates influence women's choice of obstetric hospital? Am J Manag Care. 2019 Feb 1;25(2):e33-e38
  • Sinaiko A, Mehrotra A. Why Aren’t More Employers Implementing Reference-Based Pricing Benefit Design, American Journal of Managed Care. 2019 Feb;25(2):85-88.
  • Qureshi N, Mehrotra A, Rudin RS, Fischer SH. Common Laboratory Results Frequently Misunderstood by a Sample of Mechanical Turk Users. Appl Clin Inform. 2019;10(2):175-179.
  • Zhang X, Haviland A, Mehrotra A, Huckfeldt P, Wagner Z, Sood N. Does Enrollment in High-Deductible Health Plans Encourage Price Shopping?. Health Serv Res. 2018;53 Suppl 1:2718-2734. PMCID: PMC6056587.
  • Mehrotra A, Chernew ME, Sinaiko AD. Promise and Reality of Price Transparency. N Engl J Med. 2018;378(14):1348-1354.
  • Desai, S, Hatfield LA, Hicks AL, Chernew ME, Mehrotra A. Association Between Availability of a Price Transparency Tool and Outpatient Spending, JAMA. 2016 May 3;315(17):1874-81. doi: 10.1001/jama.2016.4288.
  • Gourevitch RA, Mehrotra A, Shah N, Galvin G, Plough A, Karp MA. How Do Pregnant Women Use Quality Measures When Choosing Their Obstetric Provider? Birth. In press.
  • Mehrotra A, Hussey PS, Milstein A, Hibbard J. Consumers’ and providers’ responses to public cost reports, and how to raise the likelihood of achieving desired results. Health Affairs (Project Hope). 2012;31(4):843-851.
  • Haviland AM, Eisenberg MD, Mehrotra A, Huckfeldt PJ, Sood N. Do "Consumer-Directed" health plans bend the cost curve over time? Journal of Health Economics. 2016 Mar;46:33-51
  • Semigran H, Sinaiko A, Gourevitch R, Mehrotra A. Patients Views on Price Shopping and Price Transparency. American Journal of Managed Care. In press.
  • Mehrotra A, Brannen T, Sinaiko AD. Use Patterns of a State Health Care Price Transparency Website, What do Patients Shop For?, Inquiry. 2014 Jan 1;51.
  • Sinaiko AD, Mehrotra A, Sood N. Cost-Sharing Obligations, High-Deductible Health Plan Growth, and Shopping for Health Care: Enrollees With Skin in the Game. JAMA Internal Medicine. 2016 Mar 1;176(3):395-7. doi: 10.1001/jamainternmed.2015.7554.
  • Semigran  H, Mehrotra A, Hwang A. Drowning in a Sea of Paperwork: Towards a More Patient-Centric Billing System in the United States, Annals of Internal Medicine. 2016 Feb 2. doi: 10.7326/M15-2283.Epub ahead of print.
  • Farrell KS, Finocchio LJ, Trivedi AN, Mehrotra A. Does price transparency legislation allow the uninsured to shop for care? Journal of General Internal Medicine. 2010;25(2):110-4.
  • Sood N, Zhang X, Wagner Z, Mehrotra A, Huckfeldt P, Haviland A. The Impact of Consumer-Directed Health Plans on Price Shopping. Value Health. 2015 Nov;18(7):A515
  • Mehrotra A, Sloss EM, Hussey PS, Adams JL, Lovejoy S, Soohoo NF. Evaluation of centers of excellence program for knee and hip replacement. Med Care. 2013 Jan;51(1):28-36. PMCID: PMC3531915.
  • Mehrotra A, Sloss EM, Hussey PS, Adams JL, Lovejoy S, Soohoo NF. Evaluation of a Center of Excellence Program for Spine Surgery. Med Care. 2013 Jun 13. No PMC req.
  • Mehrotra A, Dimick JB. Ensuring Excellence in Centers of Excellence Programs. Annals of Surgery.  February 2015; 261(2): 237-9.
  • Tackett S, Stelzner C, McGlynn E, Mehrotra A. The impact of health plan physician-tiering on access to care. Journal of General Internal Medicine. 2011;26(4):440-5. PMCID: PMC3055960.
  • Kandrack R, Mehrotra A, DeVries A, Wu S, SooHoo N, Martsolf G. Patient Use of Cost and Quality Data When Choosing a Joint Replacement Provider in the Context of Reference Pricing. Health Services Research and Managerial Epidemiology. 2015 Jul 31.