Personal incentives and competition can improve quality and decrease costs. However in health care there is the risk that if you ask people to pay higher deductibles that they will forgo needed medical tests and treatments, and as a result illnesses will get worse.
At the same time, I know sites like pharmacychecker have come in handy for me. So has the $4/month prescription drug plan. Researching which pharmacy was cheapest, then buying a medicine in larger doses and breaking it into halves or quarters has worked to save me 70% of what I’d pay if I just arbitrarily picked a pharmacy and bought a medication before in regular doses.
Is there any way to use competition and incentives to drive up quality and drive down cost that does not make people forgo and avoid needed medical care? A person can ‘walk away’ from buying a DVD player or computer, but you can’t really avoid buying medical care. I’m sure people have figured out how to do this, but I don’t know how.
Would letting external agencies (comparative effectiveness boards) do the work of promoting competition rather than letting consumers do it work?
What about giving people a budget for health interventions, and letting them keep the difference? ie, if you need an MRI your insurance company says ‘we will give you $1200 to pay for an MRI. If it costs more than that you pay the difference. If it costs less you can keep the difference’. That would prevent people from avoiding medical care (since you’d get nothing, no MRI and no amount of the difference) if you avoided getting the MRI while still promoting competition and personal incentives.