Health savings accounts and consumer-directed health plans are surging in popularity these days. The allure of lower premiums and consumer engagement is powerful, but it may not work in the end. The reason? Our very human preference for simplicity, rather than complexity.

Consider, for example, how many different organizations are involved with one simple health transaction: Getting a flu shot at the doctor's office. Here is a partial list of organizations shaping this event:

* Epidemiologists who predict what flu strains will be circulating;

* Manufacturers who estimate how much vaccine to make;

* Makers of syringes and packaging materials to ship the vaccine;

* Federal government agencies that distribute vaccine;

* State government-licensed health practitioners;

* Advertising agencies hired by pharmacies, health groups and government to promote the benefits of vaccination;

* Health plans who choose different providers to be in their network;

* Employers who offer vaccine clinics on site.

A 2007 study estimated that determining the factors involved in any single health care transaction would require one billion binary questions!

Other markets - from retail stores to automobiles - are making things simpler and more straightforward for the user. A novice can now click through prompts to find out why the computer is not connecting to the Internet, for example. He does not need to understand bits and bytes to fix the problem.

"The idea of consumer-directed health care ... is going in the opposite direction in that it increases complexity for consumers, and possibly for clinicians. Using other markets as benchmarks, we would expect this push to fail, or at least to have limited success," said William B. Rouse in a 2008 study.

His theory is that health care should increase its own management of complexity to simplify things for patients, families and caregivers. And, unlike buying a car or a high-end stereo, when we're buying medical services, we can't learn from our mistakes. We are not likely to have a second occasion to choose a neurosurgeon, for instance.

The best tactic for a benefits manager faced with rolling out an HSA or CDHP is to be realistic. Temper your and your employees' expectations. If you can, tone down the communications about savvy shopping for medical services. You don't need employees feeling pressured to "shop" when they are worried about their child's head injury or their own suspicious lump.

Having people shop for medical care the way they shop for cars or stereos might be ideal, in some ways. But it is not attainable as long as the shoppers are human beings.

Linda K. Riddell is a principal at Health Economy, LLC. She can be reached at

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