Increasingly, health reform strategies are involving consumers, giving them financial incentives to be sensitive to cost, quality, or both. Cost sharing arrangements such as high deductible health plans are intended to make consumers savvy shoppers for health services.
Cost sharing does reduce use and costs. However, as the Health Insurance Experiment (and many subsequent studies) showed, when consumers reduce health care use in response to cost sharing, they reduce both unnecessary and necessary care.
In addition, consumer-oriented reform strategies assume that consumers will make wise choices about health services if they are given enough information. But studies show that consumers do not make optimal choices. They find it difficult to process complex information, and they may have limited health literary and numeracy.