Rising costs and changing attitudes about convenience and the ability to personalize life choices are driving a trend toward greater consumer purchasing power and individual responsibility in healthcare services, according to a new issue brief by experts at Rice University’s Baker Institute for Public Policy.
“Making ‘Cents’ for the Patient: Improving Health Care Through Consumerism” was co-authored by Vivian Ho, the James A. Baker III Institute Chair in Health Economics and director of the institute’s Center for Health and Biosciences, and Anaeze Offodile, a physician at the University of Texas MD Anderson Cancer Center. The issue brief explores and identifies the impetus for rising consumerism in healthcare, available levers to increase consumerism, changes underway to healthcare data management as well as points of concern with consumerism.
The idea that patients should have more purchasing power and, consequently, individual responsibility over their healthcare services has translated into a redesign of health insurance benefits, the authors said. Consumers now bear more out-of-pocket expenses (through high deductibles) before cost-sharing with the insurer kicks in, they said. “These high-deductible health plans can be coupled with a health savings account or health retirement account—or so-called consumer-directed health plans—and have predominantly manifested in the employer-sponsored market and insurance exchanges, both public and private,” the authors wrote.
According to a recent analysis, more than 30% of workers are currently enrolled in a high-deductible health plan, and nationwide out-of-pocket healthcare spending grew by 40% from 2010 to 2014, the authors said.
“By shifting the ‘first dollar risk’ through these structures to patients, the hope is that they will become more conscientious and engaged in decisions about which drugs (generic versus name-brand), treating clinician (specialist versus primary care), and treatment setting (inpatient versus outpatient) are the most appropriate to use,” the authors wrote. “In theory, this should help check healthcare costs by incentivizing the use of lower-priced options and reducing unnecessary variations in healthcare utilization.”
The authors cited several barriers against healthcare consumerism: Patients rarely have to pay the full “sticker price” for healthcare, due to insurance coverage, thereby creating a “moral hazard” by consuming more care; it can be difficult to navigate the complex U.S. healthcare system; and there is a considerable knowledge gap between providers and patients with regard to treatment plans and medical diagnoses.