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Employers, insurers shape healthcare spending more than consumer shopping, study suggests

Study focused on what consumers paid out of pocket, where comparison shopping can result in lower costs.

Jeff Lagasse, Associate Editor

A recent analysis by the Health Care Cost Institute has found that less than 7 percent of total healthcare spending in 2011 was paid by consumers for what it called "shoppable" services.

The study, authored by Amanda Frost and David Newman, focused on what consumers paid out of pocket, where comparison shopping can result in lower costs. It examined 2011 claims data from three large private insurers, representing approximately a quarter of people younger than 65 who have employer-sponsored coverage. The researchers defined "shoppable services" as the most used or highest-priced services that could be scheduled in advance; they then divided claims into categories such as outpatient/physician services and inpatient facility services.

Its findings discovered that 43 percent of the $524.2 billion in total healthcare spending in 2011 was on services that could be considered shoppable, such as non-emergency hip and knee replacements, flu shots, blood tests and colonoscopies. Consumers' out-of-pocket spending on those services comprised $37.7 billion.

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[Also: CMS: Healthcare spending growth to hit 5.8% by 2024, driven by pricey drugs]

The out-of-pocket total includes what consumers pay in deductibles, copayments and coinsurance payments for healthcare services. Since copayments are flat fees, such as $20 for a doctor visit, they aren't affected by price comparison shopping. A quarter of the money consumers spent out of pocket for shoppable services was on copayments in 2011.

Deductibles and coinsurance -- in which consumers pay a percentage of the bill -- are highly variable, however, and according to the study, they present consumers' best opportunity for shopping savings. The study found that deductibles accounted for close to half of the dollars spent by consumers on shoppable services; 27 percent, meanwhile, was tied to coinsurance payments, the vast majority of which were for outpatient/physician services.

[Also: Healthcare spending growth to dip in 2016 on high-deductible surge, report says]

"Overall, the potential gains from the consumer price shopping aspect of price transparency efforts are modest," the report said.

The study suggested that, rather than price comparison tools, employers and insurers have much more capability to affect the landscape. It cited reference-based pricing as an example; it's a framework in which employers cap the amount that they'll pay for healthcare services that vary widely in price, thus encouraging workers to make cost-effective choices.

Twitter: @JELagasse