Giving health consumers more skin in the game doesn’t always lead to them making sound health decisions.

Over four years in consumer-directed health plans, enrollees used one-quarter fewer visits to doctors every year and filled one fewer prescription drugs. CDHP members also received fewer recommended cancer screenings, and visited the emergency room more often.

These rational health consumer theory-busting findings were published in the June 2013 issue of the Health Affairs article, Consumer-Directed Health Plans Reduce The Long-Term Use of Outpatient Physician Visits And Prescription Drugs by Paul Fronstin of the Employee Benefit Research Institute and colleagues from IBM and RxEconomics, a health policy consulting firm.

These results were derived from a study of medical claims from employees working in two manufacturing companies who were continuously insured between January 1, 2006 and December 31, 2010.

Health Populi’s Hot Points: Designing health plans that are both truly consumer-directed and nudge people to make good health care utilization decisions requires a better understanding of what motivates people to seek care beyond the immediate and short-term cost dimension. While health care appears to be morphing into a consumer product based on the growing out-of-pocket costs, the product and its end-use implications are more complex than buying a razor or washing machine.

“The plan’s incentives should support health improvement and the use of high-value care that could reduce future care needs,” the authors say, quoting Regina Herzlinger, a godmother of consumer-directed health.

The two main barriers to optimal results in CDH are that:

1. People don’t have comprehensive and understandable information to help them make these decisions

2. High deductibles can motivate people to avoid necessarily health care services and products to save money.

More employers, large and small, are offering CDHPs in and beyond 2013. CDHPs will also be prevalent plans on health insurance marketplaces in 2014, selling especially to newly-insured people who aren’t as health plan literate as their peers who have been selecting health plans from employers in the past couple of years.

CDHP members need to better understand the tradeoff between using the deductible and health savings account for buying current health services to save money on future (presumably more expensive) health services. Furthermore, CDHP providers should artfully design front-end prevention into the plans by heavily subsidizing (or discounting to zero dollars, making free) targeted prevention and wellness services that channel people into self-care and early diagnosis early and sooner.