A National Survey of Value-Promoting Consumer Behaviors in High-Deductible Health Plans
More than 1 in 3 Americans with private health insurance now face high out-of-pocket expenditures for their health care because they are enrolled in high-deductible health plans (HDHPs). While the high levels of cost sharing in these plans can discourage consumers from using low-value care, they can also pose substantial barriers to their use of high-value care, particularly for individuals with chronic conditions. Recent changes in the health care marketplace such as the emergence of health care price comparison tools and alternative care settings like retail clinics offer new opportunities for consumers in HDHPs to optimize the value of their out-of-pocket expenditures. However, little is known about how often and which consumers in HDHPs engage in various value-promoting behaviors, what they perceive to be the effects of these strategies, and where there could be opportunities to enhance their use of strategies that could improve their health and financial wellbeing. As levels of cost-sharing in private health insurance plans continue to rise, understanding each of these factors is crucial to improving the value of patients? out-of-pocket health care spending.
In this project, we will field a national survey of 1,600 non-elderly adults in HDHPs (defined as private health insurance plans with an individual deductible of at least $1,250) through GfK (formerly Knowledge Networks). The sample frame will be GfK?s KnowledgePanel, which is the only large-scale online panel based on a representative random sample of the US population. We will focus exclusively on adults in HDHPs because they are more likely to engage in cost-conscious behaviors compared to individuals who have health insurance with a relatively small deductible. The sample will include an oversample of 400 HDHP enrollees with a chronic condition (diabetes, chronic obstructive pulmonary disease, asthma, hypertension, congestive heart failure, or coronary artery disease) because when facing high cost-sharing these individuals are known to forego needed medical care at greater rates than individuals without chronic conditions, yet those with chronic conditions could potentially benefit most from engagement in cost-conscious behaviors because of their predictable needs for clinical services.
First, we will develop and pretest our survey instrument. In developing this survey we will supplement relevant existing items from existing national with new measures that will capture the full range of value-promoting behaviors for which there have been widespread anecdotal reports yet no systematic data on their prevalence. We will pretest and refine these new measures among HDHP enrollees through our team?s existing partnerships with local clinics and the Detroit Regional Chamber.
In the survey we will conduct among a nationally-representative sample of HDHP enrollees, we will measure frequencies of engagement in value-promoting consumer behaviors such as using price comparison tools for different types of health care services, engaging health care providers in shared decision making that considers health care costs, choosing providers and settings of care based on their prices, and negotiating prices for services. For each behavior in which respondents engaged, we will elicit their perceptions of the degree to which the behavior helped them receive needed care and control their out-of-pocket expenditures. We will then examine variation in engagement in behaviors by individual and geographic characteristics.
Survey participants will also be shown brief clinical vignettes and asked about their perceptions of the ?shopability? of different health care services. The vignettes will be designed to contrast health care services that can generally be more shopable (e.g., routine, non-urgent services that are unlikely to vary in quality) with those that are often loss shopable (e.g., unpredictable, urgent services that can vary substantially in quality).
Robert Wood Johnson Foundation
Funding Period: 10/1/2015 to 3/31/2017