“Most Americans in HDHPs are not doing things that can help them get the care they need at the lowest possible cost, and even those who are doing so could realize more benefits,” says lead author Jeffrey Kullgren, M.D., M.S., M.P.H., an assistant professor of general medicine at U-M. (https://jamanetwork.com/journals/jamainternalmedicine/articl...)
"Research published last year in the American Journal of Managed Care showed that switching to a consumer-directed health plan—an HDHP paired with a health savings account—did, in fact, result in lower outpatient spending. But the researchers, led by Neeraj Sood, vice dean and professor at USC’s Price School of Public Policy at the University of Southern California, found no change in spending on 26 commonly used, low-value services." (https://www.managedcaremag.com/archives/2018/6/hdhps-cost-sh...)
"Current evidence suggests that HDHPs are associated with lower health care costs as a result of a reduction in the use of health services, including appropriate services" (https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0...)
First, employers should be out of the healthcare equation entirely, except in as far as either taxes or salaries are used to fund health costs the employee bears. After all, employers don't participate in many other common expenses people bear, from housing to educating their children.
Second, individuals are generally not capable of "shopping around" for the best value healthcare; they simply don't have sufficient knowledge to properly evaluate the various options. This is why you need some form of independent assessment of treatment costs and benefits, such as the UK's National Institute for Health and Care Excellence [1].
Insurance based systems with government oversight are the norm in most of Europe.
This. A million times. If there's one thing that's bugged me a hell lot as an immigrant in the US it is this. It's insane to give employers control over something as personal as your healthcare. I have been lucky enough not to have major issues with this arrangement but I have heard far too many horror stories from colleagues.
And then you get the usual people not going to the doctor when they’re sick (staple of american life) and infecting everyone.
E.g. in the UK, general practitioners negotiate as a block, and individual practices can take or leave whether or not they want to provide services for the NHS or private services. The NHS needs to offer contracts attractive enough for enough practices to take NHS patients and ensure continued recruitment, but no better. It's a market, but skewed by a very large actor with a strong interest in keeping prices down.
If they "just" let people shop around without regulating or negotiating prices (and leveraging the volume of business), then it would be a problem. But having the consumer participate in driving costs down is demonstrably not necessary. On the contrary I'd argue it's counter-productive, because when dealing with people with less money it creates a risk that people gamble on options that cost less in the short term at the expense of creating higher costs in the long run.
The idea that "The solution is to make the consumer participate in driving costs down." has been demonstrated in none of those nations for healthcare.
As a well-educated white collar worker in a non-medical field, if I broke a bone and a doctor gave me three different options and costs for setting that bone, I would really have no basis for being able to choose the right option for the best long-term cost/quality of health.
This idea is like asking regular computer users to determine what software stack they should buy to use in their cloud computing provider.
... when you or your family are on death´s door because of an accident/cancer/heart attack/stroke/bug/immune disorder etc., you may find comparison shopping isn´t the first thing that comes to mind.
There's also the problem that there isn't any price transparency in the US health care system. You literally can't find out how much many procedures cost ahead of time.
Do the employees have to pay all of their medical costs up front out of pocket and are later reimbursed $4000 through the HSA? So an employee must have the available funds to pay more than $2000 up front.
One thing I would add to that plan is to provide free annual/biannual preventive health checkups.
The incentive shouldn’t be so much that consumers stop going to a doctor at all.
This is a terrible idea. Did they learn nothing from the failure of Health Care in the United States? When insurance pays for everything patients stop worrying about costs, which in turn causes hospitals and drug companies to raise prices. This is what has caused Health Care to fail from a costs point of view.
The solution is to make the consumer participate in driving costs down.
In the US, one employer I know of has an excellent solution to the problem: Make employees pay 100% of the bill up to a certain amount, such as $6000. That's a large amount, but the employer then contributes a large amount to your Health Savings Account (HSA), such as $4000. This amount is for you to keep regardless of whether you have any health bills or not. (This money can be used for medical expenses only, but can be used any time, including after retirement). So the maximum you will spend out of pocket per year is $2000. How does this encourage the consumer to scrutinize and control medical expenditure? Because the first $6000 of medical spending in a year is "your money". This is money you'd be able to keep in your HSA if you didn't have any medical expenses. This gives the consumer a strong incentive to reduce costs, question charges, avoid unnecessary services, and so on.