Figuring out how to get the best care at a reasonable cost through a consumer-driven health plan takes practice, and doctors are often just as confused as their patients. If you're accustomed to simply deferring to your doctor's medical expertise, you may need to be more assertive about managing your care if you want to keep costs under control, new research suggests.
A "consumer driven" plan typically refers to a health insurance policy with a deductible of at least $1,000 that has some sort of financial account (like a health savings account) attached to it into which the consumer, the employer, or both can deposit money to pay for medical expenses. Because of that high deductible, patients may be responsible for paying for doctor visits, lab work, diagnostic imaging, drugs, and other medical expenses that would be covered under a traditional plan, at least until they reach the deductible. (Even if your plan doesn't qualify as "consumer driven," chances are you're paying more out of pocket every year, so these issues may concern you, too.) Some 13 percent of companies that offer health insurance have such plans now, but they're spreading: About a quarter of employers say they're at least somewhat likely to offer one next year, according to the Kaiser Family Foundation.
The idea behind consumer-driven plans is that consumers will spend more wisely if they have a greater financial stake in their own healthcare. This makes sense in theory. But the reality is that high out-of-pocket costs push people to forgo necessary care, not just the extra frills.
Which brings us to the study in question. In a survey of 1,500 primary care physicians, researchers found that 43 percent knew only a little or nothing at all about CDHPs, and an identical percentage said they had little knowledge of out-of-pocket costs faced by patients enrolled in these plans. The study, sponsored by the Robert Wood Johnson Clinical Scholars Program, was published in the October issue of the American Journal of Managed Care . "It surprised us that so many doctors didn't know about these plans," says Craig Pollack, one of the study authors and a RWJ clinical scholar at the University of Pennsylvania.
It didn't surprise me. Doctors have not been expected to factor cost considerations into the medical care equation until very recently. That may be changing somewhat. "At the residency level, costs are being talked about more, but it's still inadequate," says Ted Epperly, president of the American Academy of Family Physicians.
If patients want to make sure cost-effectiveness is part of any medical discussion, chances are they're going to have to bring it up. That means first of all understanding how your own plan works. Get the health plan description from your human resources department, and review the specifics before you go to the doctor. If your doctor recommends a particular test or drug, don't be embarrassed to ask whether there's another option that is less costly but just as effective. Naturally, that's true for generic vs. brand-name drugs, but might an X-ray be just as effective in some instances as an MRI? It's worth asking. You can't weigh complex care the way you shop for groceries, of course. But if your doctor knows you're keeping an eye on costs, maybe she'll try to do the same. Communicating about it is the first step.