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Research Letter
March 2016

Cost-Sharing Obligations, High-Deductible Health Plan Growth, and Shopping for Health CareEnrollees With Skin in the Game

Author Affiliations
  • 1Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 2Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
  • 3Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 4Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
JAMA Intern Med. 2016;176(3):395-397. doi:10.1001/jamainternmed.2015.7554

The rapid growth of high-deductible health plans (HDHP) has been driven in part owing to a belief that cost-sharing obligations (ie, having skin in the game) will encourage health insurance enrollees to shop for health care.1 The wide variation in costs across physicians and hospitals implies considerable opportunity for enrollees to save money by switching to lower-cost providers.2 High-deductible health plan enrollment is associated with lower health care spending.3,4 However, prior studies using health insurance claims data indicate these savings are primarily owing to decreased use of care and not because HDHP enrollees are switching to lower-cost providers.5 Limited prior work has assessed attitudes toward price shopping among HDHP enrollees and whether they were more likely to consider costs when seeking care.

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