Almost one-quarter of Americans with employer-sponsored health care are now in high-deductible health plans, and we know that hundreds of thousands of people securing coverage through the exchanges are as well. According the Kaiser Family Foundation, the average annual out-of-pocket costs per patient rose almost 230 percent between 2006 and 2015. With the Trump administration committed to a policy of promoting HSAs and greater price transparency, there is no doubt health care "consumerism" is here to stay. But was it ever really here to begin with?

For the past decade or longer, health care leaders and benefits professionals have been talking about consumerism: employees need to have "skin in the game" and the data and tools to help them shop for care based on cost and quality. And while the availability of data and tools to help employees shop has dramatically increased, the problem is that most still don't. A 2015 McKinsey survey of over 11,000 people found that "many, if not most, health care consumers are not yet making research-based decisions … findings indicate, for example, that only a few consumers are currently researching provider costs or even the number of providers they can choose among." Despite the proliferation of price transparency tools, studies report utilization remains low. And perhaps more concerning, use of transparency tools does not result in lower outpatient spending. 

Employees don't shop around