Trying to overcome complicated health care shopping

For well over a decade, more people have faced higher health insurance deductibles. The theory goes like this: The more of your own money that you have to spend on health care, the more careful you will be — buying only necessary care, purging waste from the system.

But that theory doesn’t fully mesh with reality: High deductibles aren’t working as intended.

A body of research shows that people do in fact cut back on care when they have to spend more for it. The problem is that they don’t cut only wasteful care. They also forgo the necessary kind.

People don’t know what care they need, which is why they consult doctors. But it runs counter to the growing trend to encourage people to make their own judgments about which care, at what level of quality, is worth the price — in other words, to shop for care.

Some care is elective and so potentially “shoppable.” Studies have shown that as much as 30 or 40 percent of care falls into this category. It includes things like elective joint replacements and routine checkups.

And yet very few people shop for this type of care, even when they’re on the hook for the bill. Maybe it’s just too complex. Even when price transparency tools are offered to consumers to make it easier, almost nobody uses them.

A National Bureau of Economic Research working paper published last Monday adds a lot more to the story. The study team from Yale, Harvard and Columbia considered a health care service that should be among the easiest to shop for: nonemergency, outpatient, lower-limb MRIs.

This is the kind of imaging you might get if you’re having some trouble with a knee or ankle, but not bad enough to need the image right away.

The study, which focused on more than 50,000 adults between 19 and 64, strongly suggests that people get their MRIs wherever their doctors advise, with little regard to price.

But the identity of a patient’s orthopedist explains a lot more about where he or she got the MRI than any other factor considered, including price and distance. Less than 1 percent of patients in the study sample availed themselves of a price comparison tool to shop for MRIs before receiving one.

By this reasoning, the authors concluded that doctors sent people to more expensive locations than they had to. On the way to their MRI, patients drove by an average of six other places where the procedure could have been done more cheaply.

“Many patients are going to very expensive providers when lower-price options with equal quality are available,” said Zack Cooper, a health economist at Yale and a co-author of the study. Though patients seem to follow the advice of their doctors on where to go, their doctors don’t have all the information on hand to make the best decisions for the patient either.

As with many health care services, there is a large variation of prices, which means a tremendous opportunity to save money by selecting lower-priced ones. In one large, urban market, prices for the procedure are as low as about $280 and as high as about $2,100.

There is no evidence that the quality of lowand high-priced MRIs differs, at least enough to be clinically meaningful. The study found that virtually none of the MRIs at any price level had to be repeated — strong evidence that the doctors relying on them are satisfied even with the lower-priced images.

At almost $1,500, the average price of a hospital MRI is more than double that of one at an imaging center. The study found that doctors who work for hospitals are more likely to send their patients for more expensive hospital-based imaging.

What this study suggests is that if people don’t shop for simple, elective MRIs, there’s hardly a chance they are going to do so with other health care procedures that are more complicated and variable.