Of Benefits and Behaviors

One of our mantras at 4sight Health is that we won’t change the way we deliver care until we change the way we pay for care. Providers will do what you pay them to do, and if you want providers to do something else, pay them to do something else. 

In journalism, that loosely translates into follow the money if you’re looking for the real story.

As it turns out, that dynamic also applies to patients. At least according to two new studies.

The first study appears in the journal Circulation published by the American Heart Association.  You can download the 14-page study here. 

Researchers from Brigham and Women’s Hospital, the University of Texas Southwestern Medical Center, the Harvard Medical School and the Harvard Pilgrim Health Care Institute wanted to know if there was a connection between the level of patients’ out-of-pocket health plan deductible and patients’ willingness to go to the emergency room with chest pain.  You already know the answer but indulge me. 

The researchers analyzed 12 years’ worth of commercial and Medicare Advantage claims from members with high-deductible health plans and a peer group of members with low-deductible health plans. They defined a high deductible as $1,000 or more a year and a low deductible as $500 or less a year.

The nearly 600,000 members with high deductibles were less likely to go to the ER with nonspecific chest pain than the nearly 6 million members with low deductibles, the study found. 

“People with higher deductibles delay treatment and are sicker when they show up in the ER for chest pain,” the researchers said. 

The second study appears in the journal Medical Care Research and Review. You can download the study here. 

Researchers from the University of Michigan wanted to know if there was a connection between patient cost-sharing levels and their use of preventative services. Again, you already know the answer but keep reading anyway.  

The researchers did a meta review of 35 original studies on the connection, specifically as it pertains to 10 high-value preventative services recommended by national experts like the U.S. Preventative Services Task Force. What they found was the elimination of cost-sharing by patients—meaning patients had no out-of-pocket costs—led to increases in the use of preventative services like breast cancer screenings, cervical cancer screenings, contraception, sterilization and immunizations. 

“Our findings suggest that low-socioeconomic status groups, and those who experience the greatest financial barriers to care, appear to benefit the most from cost-sharing elimination,” the researchers concluded. 

You don’t have to be an economist or a behavioral scientist or even work for 4sight Health to figure out what’s going on. Patients respond to financial incentives no differently than everyone else in this crazy ecosystem we call healthcare. 

If we want patients to manage their health more effectively, pay them to do it via smart health benefit designs. It’s not that complicated.

Thanks for reading.