Grant: #73054

Grantee Institution:The Regents of the University of Michigan

Principal Investigator: Jeffrey Kullgren, M.D.

Grant Period: October 1, 2015 – March 31, 2017

Budget: $246,494

Project Aim: To examine how often individuals in High Deductible Health Plans (HDHPs) engaged in cost-conscious consumer behaviors and the perceived effects of these behaviors among consumers who have engaged in them.

Key Findings:

  • Twenty-five percent of respondents talked with a provider about the cost of a service.
  •  Fourteen percent of respondents compared prices or quality.
  • Only 6% of respondents tried to negotiate a price for a service.
  • The most common reported result of saving for health services (53%), comparing quality (52%), and discussing cost with a provider (45%) was help with getting a needed service.
  • The most common reported result of comparing prices (45%) and trying to negotiate a lower price (52%) was paying less for a service.
  • The most common consumer behavior was saving for future health services, but less than half (40%) of surveyed HDHP enrollees engaged in this behavior.

Project Description:

The researchers examined the extent to which consumers who are in high-deductible health plans (HDHPs) engage in behaviors that help them optimize value. Employing a nationally representative survey, the researchers explored: (1) how often and in what situations consumers engage in key value-promoting behaviors such as budgeting for health services, choosing settings of care based on price and/or quality, engaging in shared decision-making with providers that considers cost, and negotiating prices for services; (2) which consumers are most likely to engage in these behaviors; (3) which behaviors consumers find most beneficial in maximizing the value of their out-of-pocket (OOP) expenditures; (4) what are the facilitators of and barriers to consumers’ engagement in value-promoting behaviors; and (5) what are consumers’ attitudes and intentions towards engaging in value-promoting consumer behaviors in specific clinical situations. The goal of this project was to inform policymakers, payers, health systems, providers and consumers about the frequency and perceived effects of value-promoting consumer behaviors in HDHPs.

This project was funded as part of the Robert Wood Johnson Foundation’s solicitation “Optimizing Value in Health Care: Consumer-focused Trends from the Field,” which supported studies that addressed consumer perceptions of value in the new and emerging health care landscape.


A Survey of Americans With High-Deductible Health Plans Identifies Opportunities to Enhance Consumer Behavior 
Health Affairs | March 2019

Attitudes About Consumer Strategies Among Americans in High-deductible Health Plans   
Med Care | Jan 2019 

Most Individuals Enrolled in High-Deductible Health Plans Are Not Engaging in Cost-Conscious Consumer Behavior  
AcademyHealth | June 2018

Consumer Behaviors Among Individuals Enrolled in High-Deductible Health Plans in the United States
JAMA Internal Medicine | November 2017