a consumer-driven health plan save company money? Of course it will, just like
raising deductible or office visit co-pay save money. Itís called cost
shifting. The trick, of course, is sustained cost savings and, more importantly,
changed behaviors. Here is where the jury is still out, and will be for a long
problem in part is that we have the cart before the horse. In todayís
environment, a consumer-driven plan will at best cause a patient to defer or
delay mostly primary care, but is unlikely to impact specialist care (because
that is typically perceived as potentially serious care) or inpatient care and
the like. I am not sure that we know what we want consumer-driven health care to
be and that, more often than not, we hide behind a high-deductible plan and HSA
while we simply ask the employee to pay more. Isnít it ironic that large
companies "canít afford health care," while shifting premiums and
out-of-pocket costs to workers, even low-paid workers, is merely accepted as a
of todayís benefit professionals were not in the business when health plans
always included deductibles, applied reasonable and customary fees (with the
excess fee all the patientís responsibility) and all outpatient services,
including prescription drugs were reimbursed at 80%. Before 1975 or so, the
typical employee had considerable skin in the game as we like to say, and yet,
it did little to control health care costs. I suspect the same will hold true
for the consumer-driven movement after the initial cost-shifting impact.
as some would point out, consumer-driven plans are not about high deductibles
and HSAs, but rather the educated consumer who will question the need for care,
for tests and will seek the best care at the best price. And how will they do
that with little, if any, real quality information available or for that matter
even a well-defined definition of "quality?"
get me wrong; Iím not saying we should give up, just be realistic and not get
caught up in the hype of a new plan design. Itís happened before. Clearly,
there is great value in working toward an involved, educated consumer armed with
facts and figures and able to identify the health care system that works best.
But if we allow ourselves to be seduced by the HSA and high-deductible plan as
the panacea; we will lose focus where the value truly may lie. Right now, the
patient is bounced around the health care system like a pinball and having them
take the first $1,500 in bills out of their pocket doesnít give them control
over the flippers.
progress is being made in measuring quality care, but we have a very long way to
go. Employers would do well to place their resources in this effort rather than
investing in yet another change in the benefits plan. Letís aim for the day
when the best hospital for each procedure is routine information and the normal
topic of discussion between patient and physician. Letí s expect that when you
enter a physicianís office, you see a list of fees and have already evaluated
how he or she follows standard protocols and how well patients are monitored.
Letís demand that information about the best drug come not from the last
representative who walked through the door, but from objective sources used by
the doctor. Then we may have consumers driven to demand more for not only their
dollar, but for their health.