It makes good sense to have all of us more involved in our healthcare decision-making and with that its payments. But individuals purchase healthcare in a manner unlike any other purchase. Patients or their loved ones do not “shop” for the best price the way they shop for a new washing machine. They shop for the best [as they understand it] physician, hospital, etc. Mostly they accept the advice of their personal physician as to drugs, surgery or rehab. That said it makes sense to have high deductible policies with or without health savings accounts or medical savings accounts (HSAs/MSAs.) We should not be fooled that these will necessarily lead to substantially more prudent purchasing as their proponents believe. Their real value is to give individuals the opportunity to purchase care with pretax dollars, a nice saving, and to help put insurance back to being true insurance for catastrophic expenses and not prepaid total healthcare as is most insurance today.
The biggest drivers of costs are related to the lack of preventive care for many of us and the lack of good care coordination for those of us with complex chronic illnesses (e.g., heart failure, diabetes with complications) as discussed in the previous post. These will not be affected much if at all by patients having more “skin in the game.”
But the more we know about our medical care costs and the more we ask our providers why a test, a drug or a procedure is necessary then the more likely it becomes that there will be a reduction in total costs. Being more directly invested in the costs of our care will ultimately have a market effect. This is particularly important when told to get a test, X-ray or drug. Ask your physician if the test is really important or is just being done to “be complete” (i.e., avoid malpractice litigation.) Will the results really effect what the doctor decides to do next? And as for drugs, is a drug what is needed or is it a life style change such as Lipitor versus a change in diet and exercise? Or is a generic available? Or another drug that is equally as effective as the branded drug? It is our money so it is important to have these discussions. Unfortunately, as patients we still have an information gap relative to our provider and we tend to accept advice without questioning – this needs to change and being directly responsible for dollars spent may just provoke that change.