With health insurance premiums on an every-increasing trend, employers and individuals have been looking for ways to cut costs. High deductible health insurance plans in combination with health savings accounts have been widely touted by government officials as a way to lower costs. Indeed, the premiums for an HDHP are generally lower than premiums for a more comprehensive health insurance policy. But the other hoped-for effect of having insured patients act more like market-savvy consumers when it comes to health care, has not been realized yet.
Employers and other big purchasers of health care expect much from an injection of consumerism into the market for health services,” but “even the most ardent advocates acknowledge that consumer-directed health care still has far to go before delivering its hoped-for results.
Some states have created quality comparison report cards for health care providers, but many people do not know about them or do not trust them. People still rely on the tried and true method of asking friends, family, and primary care physicians for referrals. And in areas with only one main hospital, it doesn’t really matter what the report card says – everyone is going to use the same hospital if it’s the only choice.
So patients have not become comparison-shopping consumers when it comes to health care. One has to wonder if this will change as time goes by and health insurance premiums continue to rise. When Jay needed to have a lipoma removed last summer, we shopped around extensively. We knew that we would be paying out of pocket, since the lipoma was excluded on our health insurance policy. So we comparison shopped just about every dermatologist in our area of Colorado.
Several months ago, Jay injured his knee, and he decided that it was not getting better on its own. From internet research, he determined that it was likely going to need surgery, which we knew would cost more than our $3000 deductible, regardless of where he went. And we knew that this would be covered by our health insurance. So instead of shopping for cost, he went shopping for quality. He’s currently being treated at the Steadman-Hawkins clinic in Vail Colorado, widely regarded to be one of the best knee treatment centers in the world. Dr. Steadman has put back together quite the hall of fame – John Elway, Kobe Bryant, Picabo Street, Bode Miller, Terrell Davis, just to name a few. And now he’ll work his magic on Jay. He’s on our Humana health insurance network, so once we meet our $3000 deductible, Humana will cover the rest, just as they would have if Jay had chosen to go to the first knee surgeon he found in the telephone book in Denver.
So in both of those cases, we’ve been educated health care consumers, but with two different aims in mind. For the lipoma, obviously we wanted to get the job done right, but it was a relatively simple procedure and didn’t involve any joints that need to last a lifetime. And we had to pay for it ourselves. So trusting that it would get done correctly by whomever he chose, Jay picked the clinic that quoted the lowest price. Which turned out to be not quite true, but that’s another story.
In the case of his knee, knowing that the knee was far more important to his health and happiness than a patch of soft tissue on his back, and knowing that our out of pocket would be $3000 regardless of what network physician he chose, Jay picked the very best doctor he could find. We contributed to our HSA throughout 2007, so we’ll be able to meet the deductible using HSA money, just as the HDHP/HSA system was designed to be used.
When Jay went in for his first appointment last week, the office manager commented on how high our deductible is. Apparently they don’t see $3000 deductibles that often. HDHPs are still not that common, and the majority of people are scared to have a deductible that qualifies as “high.” So it would be unrealistic to expect that we would have turned into a nation of savvy health care consumers by now. But if more and more people start buying health insurance policies with truly high deductibles, it makes sense that costs will go down and quality of care will go up as consumers demand more for their dollars.
