Americans aren't the savviest health care customers. We spend substantially more than those in other developed countries, according to the Kaiser Family Foundation (KFF). Despite shelling out 13 percent more for health care than the next highest-spending country, and about 90 percent more than in many other countries considered global competitors, we don't achieve substantially better health care results, according to KFF. In the U.S., we spend more than $6,500 per person for health care each year, which means 16 percent of the economy goes to health care.

If you have group health insurance through your employer, you likely have a comprehensive health plan that pays for most treatment, from preventive care to major surgery, in exchange for your premiums and co-pays. Now, what's become known as consumer-driven health plans (CDHPs) plans shift more costs to you in the hopes that you'll become a more better health care customer.

The definition of a CDHP may vary depending on whom you ask, but the Employee Benefits Research Institute (EBRI) defines a CDHP as a plan with an annual deductible of at least $1,000 for an individual and $2,000 for a family and that's linked to a tax-exempt health savings account (HSA) or health reimbursement account (HRA), in which you or your employer deposit money to use for medical expenses. For more, read Health care account comparisons: FSA, HRA and MSA.

Very similar are high-deductible health plans (HDHPs), which EBRI defines as plans with low premiums and high deductibles but without the savings account.

CDHPs are making small but noticeable inroads in the health insurance market. According to EBRI, 2 percent of adults were enrolled in consumer-driven health plans in 2007 (that's 2.3 million people ages 21 to 64), up from 1 percent in 2006 and 2005. Additionally, HDHP enrollment increased from 9 percent in 2005 to 11 percent in 2007 (totalling 12.5 million people).

How it works

Few of us research the true costs of our health care decisions. For our $20 co-payment, we get the prescription we want without pausing to ask what the retail cost would be.

Under a consumer-driven approach, your employer still contracts with insurers for group health insurance. You may be able to choose your own annual deductible level and you can see any doctor you want without a referral. However, your share of costs and risk is substantially more than with, say, an HMO.

For example, you may pay the first $1,000 to $3,000 of your medical costs out of your own pocket. Once your deductible is reached, your plan kicks in and covers a percentage of your medical costs, perhaps 80 to 100 percent.

One of the fundamental ambitions of CDHPs and HDHPs is that you take control of your health care spending through deposits to and withdrawls from your HSA, HRA or MSA. So far, this element hasn't fully panned out. According to EBRI, in 2007, 42 percent of people with a HDHP were eligible for an HSA but hadn't opened an account. Thus, 5.2 million people were paying for out-of-pocket medical expenses without taking advantage of tax-exempt savings plans.

Another benefit touted by consumer-driven plans is that you'll become a better health care customer because you're spending more of your own money. EBRI research shows that folks with consumer-driven plans are indeed somewhat more cost-conscious health care customers than those in comprehensive plans. According to EBRI:

• 74 percent of adults in CDHPs and 60 percent in HDHPs "strongly" or "somewhat agreed" that the terms of their coverage made them consider cost when deciding to see a doctor when sick or fill a prescription; compared to 47 percent of those in more comprehensive plans.
• Adults in CDHPs and HDHPs were more likely (2 in 5) than those in more comprehensive plans (about 1 in 3) to say that they asked their doctor to recommend a less costly prescription drug.
• 27 percent of adults in CDHPs and HDHPs said they checked the price of a service prior to receiving care, as opposed to 21 percent of those in comprehensive plans.
• People in CDHPs were more likely to say they participated in employer-sponsored wellness programs.

A lack of cost and quality information continues to dog consumer-driven plans. For patients who tried to find information about cost and doctor quality, between one-half and two-thirds said they found useful information. How can one one be a smart shopper without the necessary cost and quality information? It can be like arriving at the grocery store check-out without knowing how much your items cost but with only $10 budgeted to pay for them.

The plans themselves don't always provide comparison information: 23 percent of adults in HDHPs and 25 percent in CDHPs sought information from sources other than their plans on the cost and quality of care provided by doctors, compared with 17 percent of those with more comprehensive plans. Among those who had been admitted to a hospital, or had a family member admitted to a hospital, in the last two years, 34 percent of those in CDHPs tried to find information on hospital cost and quality, compared with 22 percent in HDHPs and 18 percent in more comprehensive plans.

Nonetheless, EBRI says that in 2007 people with CDHPs and HDHPs used health care services at about the same rate as those with comprehensive medical plans. Despite this, they reported delaying or skipping needed health care more than those in comprehensive plans. About 3 in 10 adults in CDHPs and HDHPs delayed or avoided care, according to EBRI — nearly two times the percentage of those in comprehensive health plans (16 percent). About 1 in 5 of all adults with CDHPs and HDHPs said they delayed or avoided a needed visit to a doctor, over 10 percent avoided needed visits to specialists, and 9 to 10 percent delayed or avoided lab or imaging tests.

Unfortunately, delayed medical care can end up being more costly when conditions worsen or go undiagnosed.

Comprehensive plans still more highly regarded

Those in CDHPs were "somewhat more satisfied" with their plans in 2007 than they were in 2006, according to EBRI, and there was a significant increase in CDHP enrollees who said they were "extremely" or "very" satisfied with the quality of care they received and with the quality of their health plan overall. Also, there was a big increase in CDHP enrollees who said they would be "extremely" or "very" likely to recommend their plan to a friend or co-worker and to stay in their plans if they could change. However, these measures all get lower marks than more comprehensive plans.

People in HDHPs give their plans the lowest marks among all plan types.