Jost discusses consumer-driven health plans

In the latest installment of the Columbia Journalism Review‘s “Excluded Voices” series, Trudy Lieberman, president of AHCJ’s board of directors, talks with Timothy Jost about consumer-driven health plans. Jost, a law professor at Washington and Lee University and author of “Health Care at Risk: A Critique of the Consumer-Driven Movement,” says that, while there are many specific types of consumer-driven plans, they all, at heart, shift the responsibility to pay for health care to the consumer.

Jost said the idea behind such plans was that, once they had shouldered the payment burden thanks to deductible averaging around $4,000, consumers would go to the doctor less frequently and be more cost-conscious during the visits they do make. Jost takes issue with the assertion, saying that data show that workers with consumer-driven plans are healthier simply because the healthy workers are more likely to switch to consumer-driven plans than their less-healthy counterparts.

According to Jost, consumer-driven plans may lead to cheaper insurance, but not to cheaper or more effective care.

“People in high deductible plans have a harder time getting care. They are more likely not to fill prescriptions or go to the doctor, and less likely to get the health care they need. A study by the RAND Corp. showed that consumers could not discriminate between non-essential care and necessary care, and they basically saved money by not going to the doctor.”

Furthermore, Jost says, consumers can not be relied upon to drive down health care costs by “shopping around” because they lack the information and clout to be as effective as the federal government or private insurers.

Jost says they also raise legal issues, such as whether doctors are obligated to provide information about cost as well as risks and benefits or if insurers are liable to patients or providers if they provide incorrect information in their quality rankings.

3 thoughts on “Jost discusses consumer-driven health plans

  1. Martin Trussell

    The statement by Jost, “People in high deductible plans have a harder time getting care. They are more likely not to fill prescriptions or go to the doctor, and less likely to get the health care they need,” was not substantiated. Is this an opinion, or statement of fact? It is contradictory to studies published by the BlueCross Blue Shield Assoc. and CIGNA. Just curious about the source of that information.

  2. Timothy Jost

    Responding to post by Martin Trussell. This is not simply a statement of opinion, but is substantiated by empirical studies. A number of sources, most notably the annual EBRI consumerism in health care study, but also independent studies, show that persons with high deductible policies have trouble accessing care, particularly pharmaceuticals. Recent studies of the underinsured, including a study published by Health Affairs last summer, further document this. See
    The recent Blue Cross/Blue Shield study is confusing, as I recall, because on the one hand it claims that consumer-driven plan participants are reducing health care use, but it also claims that they are not less likely to go to forego particular forms of common health care. One general problem in this area, moreover, is that studies sponsored by insurance companies using proprietary data usually present a much rosier picture of the consumer-driven plan experience than do independent studies. I do not have my consumer-driven sources with me today, however, and will be happy to respond further over the weekend when I have access to them again.
    Tim Jost

  3. Timothy Jost

    The November 2008, EBRI Consumer Engagement in Health Care Survey found that HDHP enrollees were more likely than traditional plan enrollees to report that they had delayed or avoided getting care because of cost. Although the 2007 survey found that enrollees in consumer-driven plans were significantly more likely to report delaying or avoiding care than enrollees in traditional plans because of cost, the 2008 report states that this difference has disappeared because traditional enrollees are having more problems accessing care. Their data, however, shows that enrollees in CDHPs with health problems are still more likely to delay or avoid getting care than enrollees in tradtional plans. Other studies cited in my book also demonstrate that persons with high deductible policies and consumer-driven policies have difficulty accessing health care.

    The 2008 Blue Cross study illustrates the problem I have with industry studies in this area. It claims that utilization of health care by persons with CDHPs is dramatically reduced, but also states that use of diagnostic imaging, outpatient procedures, ER visits and inpatient procedures is almost identical for persons with HSA accounts and traditional plans. These are, of course, where the major costs are found in health care. So where are the savings? Data is presented very selectively and opaquely in industry reports, making it difficult to analyze.

    Tim Jost

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