Health Care Consumers Really Are Sensitive to Prices

Isn’t it encouraging to hear more evidence of the success of consumer-directed health care? By which I mean the idea of making members put some skin in the game, as the overused metaphor has it.

Just what success do I refer to? Well, there is that report from the Center for Studying Health System Change, which tells us that 20 percent of Americans went without needed medical care last year, most of them blaming high cost.

Some employers push those high-deductible “consumer” plans on the stated theory that people will choose more cost-effective care options and will forego unnecessary care. But it stands to reason that they will forego necessary care too, if their out-of-pocket cost is too high. Let’s face it: Health care isn’t cheap, and now neither is gas. Readers of this journal are not exactly economically representative of median America, where folks might have to choose $4.50-a-gallon oil over $4.50-a-pill maintenance drugs because if they can’t get to work, they can’t buy anything at all. Median (not per-capita) household income was $48,000 in 2006. I don’t have to tell you that means half the families have incomes below $48,000.

The New York Times reported that the lead author of the CSHSC study suggested that it wasn’t just high-deductible plans that led to the voluntary denial; it was likely, he said, that the cost of care has finally gotten just too high for a lot of people. Guess I jumped the gun, blaming it on plan designs with high out-of-pocket costs. Or was I just being tongue-in-cheek? You decide.

Health plans do what they can to keep a lid on costs, but it ain’t easy. In this issue, we discuss the need to ensure adherence to specialty pharmaceuticals so as to get the most bang for the buck and a Leapfrog initiative on hospital length of stay. But we also take note, in our cover story, of a trend that could be bad for costs — physician-hospital integration — while at the same time offering the prospect of more highly coordinated care.

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