An Idea That Beats “Skin In The Game”

Jeff Rosen hosted the Cavalcade of Risk this week – be sure to head over and check it out.  I particularly liked the post from David Williams about an alternative to having “skin in the game”.  When patients have to pay a more-than-nominal fee for significant healthcare procedures, the hope is that this “skin in the game” will make them forego unnecessary procedures in order to save money.  But healthcare doesn’t lend itself well to comparison shopping or frugal tactics.  For the most part, patients tend to go along with the recommendations of their doctors, especially when it comes to decisions related to major (ie, expensive) procedures.

David points out that healthcare isn’t like a shopping spree at the mall.  He believes “… that patients actually just want to get better and that they will be willing to forego expensive services and products when it makes sense to do so.”  I agree.  And David links to a study that found evidence-based decision aids can indeed result in fewer healthcare procedures by helping patients determine when the treatment in question is likely to be effective.  The study only looked at hip and knee replacements, so it’s limited in scope.  But it makes sense that providing clear, concise, evidence-based information to patients (before encouraging them to take an active role in their healthcare decision making) would be a good way to go curtail healthcare spending.  It also makes more sense to use this method than to simply take a financial “skin in the game” tactic.  The latter approach tends to limit the ability of lower-income patients to access care – even when it’s very necessary – and probably doesn’t do much by itself to reduce the use of care by more well-off patients.

Patient education holds a lot of promise in reducing unnecessary healthcare spending.  Patients have to play an integral role in the decision making process regarding their healthcare, but they have to have real information available to them in order to do so.  Making patients pay more for their care will likely reduce overall health care spending, but it doesn’t specifically target unnecessary  health care spending.  Rather, it reduces spending for people who are the most money-conscious and/or financially struggling, and those with less-comprehensive health insurance.  I like the study David writes about because the goal there is to help patients make better decisions based on sound evidence rather than money.

About Louise Norris

Louise Norris has been writing about health insurance and healthcare reform since 2006. In addition to the Colorado Health Insurance Insider, she also writes for,, Verywell, Spark by ADP, and Boost by ADP, and Gusto. Follow on twitter and facebook.

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