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Forced consumerism in healthcare, driven by patients having increased “skin in the game,” has not generated tangible systemic value but has led to fragmentation. Patients face increasingly expensive choices for potential treatment paths without clear guidance on the quality or value of those options. This information asymmetry forces patients to navigate a complex web of providers and services to discover the most affordable option within the constraints of provider networks and referral patterns. They also face the added challenge of evaluating direct-to-consumer options, which may be more affordable but often exist outside of the “traditional” healthcare system. The complexity of this task is further compounded by the lack of price transparency in the U.S. healthcare system.This week, we examine how fragmentation within the healthcare system creates gaps in care and inconsistent quality, fostered by forced consumerism (Trend 6).
Although high-deductible health plans (HDHPs) were introduced to reduce employee spending on healthcare by increasing employee control, deductibles for these plans have continuously increased, diverging from this original purpose. Since 2007, average deductibles for employees with HDHPs that include savings options, like Health Reimbursement Arrangements (HRAs) or Health Savings Accounts (HSAs), have risen by 54.2%, reaching $2.7K in 2024 (Figure 1). After accounting for employer contributions, the net increase in HDHP deductibles is 66.6%, reflecting how increases in employer contributions are not keeping pace with growth in HDHP deductibles. The increasing financial responsibility has left many employees struggling to cover out-of-pocket costs, prompting some to delay or forgo necessary care, ultimately undermining the intended benefits of HDHPs.
Nearly half (47%) of insured Americans and 85% of uninsured Americans find it difficult to afford healthcare costs (Figure 2). The financial strain not only limits access to care but may also contribute to the growing number of patients seeking non-traditional sources of health information. While most Americans (82%) still trust primary care providers (PCPs) as a source of health information, the high costs of care and undersupply of PCPs can serve as a barrier to solely relying on physicians for direct health advice. Notably, a quarter of Americans report trusting social media content creators for health information, compared to 52% who report trust in national health authorities. To the extent that unaffordable or unexpectedly high-cost care causes people to distrust or avoid seeking care from traditional providers, the more challenging care coordination becomes.
Across age groups, 65% of patients prefer in-person visits to telehealth visits. Surprisingly, patients aged 18-27 and 38-47 reported the highest preference for in-person care, at 71.7% (Figure 3). Despite a clear preference for in-person care, many health systems are continuing to prioritize investments in digital tools like telehealth. As of 2024, the leading investment focus for health systems is expanding virtual health to enhance patient experience and access, with 88.5% of health system executives having implemented or planning investments in this area.1 Additionally, 42.3% of leaders believe that at least 20% of all care types could be delivered virtually, highlighting a potential gap between patient preferences and health systems' digital strategies.