Consumer-Directed Health Care: Early Evidence About Effects on Cost and Quality

Melinda Buntin et al.


This is archived content; for historical reference only.

Increasing evidence suggests that “consumer-directed” health plans can restrain both health care costs and utilization. However, what remains unclear is whether these high-deductible plans will deter consumers from getting the care they need, according to a CHCF-funded analysis published in 2006 in the journal Health Affairs.

In the lead paper of a seven-article Health Affairs package on consumer-directed health care, economist Melinda Buntin and her colleagues from RAND also note that enrollees in consumer-directed plans tend to be healthier and wealthier — though not younger — than enrollees in more traditional comprehensive plans.

In a second paper, Jill Yegian, director of CHCF’s Health Insurance Program, reports on an October 2005 expert roundtable, “Coordinated Care in a ‘Consumer-Driven’ System,” that explored bringing together the best of consumerism and managed care. In the article, Yegian outlines concrete steps purchasers, health plans, and regulators can take to prevent increased cost sharing from harming chronically ill patients.

Among the issues raised by the authors is the lack of rigorous data to enable researchers to answer critical questions about the effects of consumer-directed health plans. To fill this gap, RAND is undertaking a four-year, $4 million study co-sponsored by CHCF and the Robert Wood Johnson Foundation. The study will examine the effect of high-deductible health plans (with and without spending accounts) on use and quality of care, including differential effects based on health status, income, and other factors.

Also included are perspectives on consumer-driven health care from the following experts:

  • Peter Lee, president and CEO of the Pacific Business Group on Health, and Emma Hoo, PBGH director of value-based purchasing;
  • Tony Miller, managing director of Lemhi Ventures and co-founder of Definity Health;
  • John Goodman, president of the National Center for Policy Analysis;
  • Marjorie Ginsburg, executive director of Sacramento Healthcare Decisions; and
  • Murray Ross, Kaiser Permanente director of health policy research.

The complete package of articles is available free of charge on the Health Affairs site accessible through the External Links.