Must-Read: Zarek C. Brot-Goldberg et al.: What Does a Deductible Do?: The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics
Must-Read: Yes. When the stakes are large, the pricing structure is complex, transparency absent, and opportunities for social learning spotty, people are really lousy consumers. Why do you ask?
: What Does a Deductible Do?: The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics: “Measuring consumer responsiveness to medical care prices is a central issue…
…in health economics and a key ingredient in the optimal design and regulation of health insurance markets. We study consumer responsiveness to medical care prices, leveraging a natural experiment that occurred at a large self-insured firm which forced all of its employees to switch from an insurance plan that provided free health care to a non-linear, high deductible plan. The switch caused a spending reduction between 11.79%-13.80% of total firm-wide health spending ($100 million lower spending per year)…. Spending reductions are entirely due to outright reductions in quantity. We find no evidence of consumers learning to price shop after two years in high-deductible coverage. Consumers reduce quantities across the spectrum of health care services, including potentially valuable care (e.g. preventive services) and potentially wasteful care (e.g. imaging services)…. Consumers respond heavily to spot prices at the time of care, and reduce their spending by 42% when under the deductible, conditional on their true expected end-of-year shadow price and their prior year end-of-year marginal price. In the first-year post plan change, 90% of all spending reductions occur in months that consumers began under the deductible, with 49% of all reductions coming for the ex ante sickest half of consumers under the deductible, despite the fact that these consumers have quite low shadow prices. There is no evidence of learning to respond to the true shadow price in the second year post-switch.