All Things in Moderation

The New York Times has an article on the the slowdown and leveling off of health care cost, as a percentage of GDP. The economy is undoubtedly a factor, as people simply delay care. But consumer-directed plans might also be a factor.

Many experts — and the Medicare and Medicaid center itself — point to the explosion of high-deductible plans, in which consumers have lower premiums but pay more out of pocket, as one main factor. The share of employees enrolled in high-deductible plans surged to 13 percent in 2011 from 3 percent in 2006, according to Mercer Consulting.

That means thousands of consumers with an incentive to think twice about heading to the doctor. One study by the RAND Corporation found that health spending among people who shifted into a high-deductible plan dropped 14 percent — though the study also found that enrollees cut back on some care that tended to save money in the long run, like vaccinations.

The article notes that there also haven’t been any big “blockbuster” drugs released in the past few years.

I think that makes the case for high-deductible and/or consumer-directed care. Patients that are insulated from the true cost of care will consume more. Shift costs their way and they consumer less.

Across the silos of care the only constant is the patient. Policymakers are being on “patient-centeredness,” but that typically means some way of monitoring and tracking patients. I think these can be a useful tool to complement, but not replace, what ultimately has to be the patient’s responsibility.

Unfortunately, the ACA makes the high-deductible plans more expensive and subjects them to the same requirements to offer “free” preventive care and the like, thus defeating the purpose.

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