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The Myth of Health Care Consumerism

Last weekend I heard several great presentations at a meeting convened by Jeff Goldsmith, but one contained a point I hadn’t heard nailed down before. Kaveh Safavi MD JD, from Thomson Healthcare’s Center for Healthcare Improvement, detailed the results of several large sample surveys on consumers’ attitudes toward web-based health care information.

One of Dr. Safavi’s opening slides came from Solucient’s HealthView Plus 2006 data, and was focused on "Quality-Driven Consumers," people who are "likely to research ratings information on hospitals or doctors," and likely to change providers if the one they originally preferred received a low rating. Strikingly contrary to the conventional wisdom, this group makes up only 19%, or one-fifth, of American adults.

Qualitydriven_consumers

The other categories are equally interesting. About one in eleven of us (9%) are "likely to
research" but "unlikely to change." This group goes through the motions of
investigation but won’t switch when they find information counter to
their original preference. 

One-third of us (34%) lackadaisically go with the flow. They are "unlikely to research" and "unlikely to change."

And (this is my favorite) nearly two in five of us (38%) are "unlikely to
research" but "likely to change," traits one audience member suggested be renamed to "Ignorance On Fire.")

Assuming the trends described here hold up, these data have critical weight for the many health care organizations that are focused on consumer empowerment. If only 19% of America’s 200 million adults engage to discover health care information that can be meaningful to their own circumstances, then that changes things considerably. 38 million or so people is still a big number, but it is a lot less than 200 million.

And that raises some questions. Will consumers use Personal Health Records? When they discover they have a particular condition, will most people dive into the available resources to become knowledgeable about it? Will the numbers described by the survey change as technology evolves and we evolve along with it? Is our broad resistance to pursuing information that is in our own interests a passing cultural phenomenon, or is it a steadfast part of the human condition?

The data go on to show that Quality-Driven Consumers are predominantly higher income, boomers, and Gen X adults. My guess is that education, a comfortable technology proficiency, and reasonably good personal management skills are common threads here.

But the subtext of this information is undoubtedly that the most important changes coming in health care will occur not only in the ways that consumers get and act on information, but in the ways that organizations – health care and non-health care businesses – do. Even though health care information can have serious utility for individuals, many of us simply don’t appear to be built to chase and use it. Businesses are different though. Most are based on a discipline of following through, and they succeed or fail on their ability to use information effectively.

All of this re-enforces my belief that, while we’re in a fascinating, rich early stage of Health 2.0, where many of the sites are focused on consumer empowerment, the bigger play will be for sites that, in an increasingly competitive and value-sensitive marketplace, create value by helping health care purchasers and vendors of all types make better, data-driven decisions.

This will become meaningful as it becomes more and more possible for businesses to buy coverage based on which health plan has the best performance record. Or as health plans really do try to assemble the most efficient (rather than simply the largest) provider network. Or as hospitals focus on identifying the best performing hip for their hip-replacement patients. Or as doctors determine to follow a condition-specific protocol that has a track record of consistently producing the best outcomes at the lowest costs.

Consumer-oriented applications are easier and cheaper to develop and bring to fruition than business-oriented, data-intensive ones. But the imperative to succeed in an intensifying marketplace could ultimately swing the pendulum toward Health 2.0 applications aimed at business. If and when it does, then the resulting transparency, decision-support and impact on market dynamics could drive many of tremendous changes in health care that we’ve all been looking for.

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StephenKatterineTex B.Maggie Maharjd Recent comment authors
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Stephen
Guest

very good article and the Health Industry has grown to such a large extent these days that no person could afford to live without insurance

Katterine
Guest

The current situation is far from consumer/patient friendly. It is all about big corporations/insurance companies, drug companies, and huge health organizations, all in bed with the big government, and their regulations. The regulations are carefully crafted not to hurt the major players, that is, the government, and the large companies. Instead, the major players should be the physicians and the patients! Whenever there is talk about consumer driven health, some commentators argue against the consumer driven healthcare, based on the assumption that people do not want to take responsibility to educate themselves sufficiently to be able to make their own… Read more »

Katterine
Guest

The current situation is far from consumer/patient friendly. It is all about big corporations/insurance companies, drug companies, and huge health organizations, all in bed with the big government, and their regulations. The regulations are carefully crafted not to hurt the major players, that is, the government, and the large companies. Instead, the major players should be the physicians and the patients! Whenever there is talk about consumer driven health, some commentators argue against the consumer driven healthcare, based on the assumption that people do not want to take responsibility to educate themselves sufficiently to be able to make their own… Read more »

Tex B.
Guest

Consumerism does work in some markets, but not at all times. Certain brands are more successful because they make a reliable product and consumers base their perceptions on that–Toyota and GE for instance. There are also success stories for poor products–Microsoft’s Vista operating system. Consumerism is a tricky thing. How it plays out will be interesting. Will the web sites that rate healthcare quality become as successful as Consumer Reports in driving purchases?

Peter
Guest
Peter

“But why shouldn’t the auto industry have an interest in producing an electric car?”
jd, glad you asked. Because electric cars only require a fraction of the parts and service. Rent a DVD titled, “Who Killed The Electric Car”. You’ll see how consumerism was killed by big oil, big auto and their “fixing” the system in big government (another GW Bush victory). CARB (CA Air Resources Board) played a big part as well.
This is why consumerism in healthcare doesn’t stand a chance, there’s too much being made by inefficiency.

Maggie Mahar
Guest

Brian– I agree completely regarding consumers. The “two in five of us (38%) who are “unlikely to research” but “likely to change” says it all. (And “ingnorance on fire” is a great line. Regarding employers, I’m just not convinced that most will make better use of information to try to select high quality care. Though I wish that were true. But most don’t expect to hold onto their employees for 10, 15 or 20 years, and thus they’re inclined to choose health care plans based on price rather than whether the plan will promote long-term health (through chronic disease management,… Read more »

jd
Guest
jd

Peter, Your last question is the trillion dollar question here Clearly the oil industry does not have any interest in conserving oil, except to the extent that a long slow decline in supply would be more profitable than a rapid decline in supply. But why shouldn’t the auto industry have an interest in producing an electric car? They don’t make money off oil, so why should they inherently care if the car they make runs on oil or electricity or gumdrops? They don’t, and Toyota is a good example of how being willing to lead the way can be profitable.… Read more »

Peter
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Peter

1. All 2. Perception is everything. Are costs being reduced? 3. The ones that confirm your existing perceptions. 4. Lots of existing evidence and history out there. 5. Politicians – campaign donations, lobbying jobs Employers – reduced costs Insurers – higher premiums, lower claims Providers – higher fees, less outside controls Consumers – same habits, less cost 6. See #5 7. Have they ever tried, I mean, REALLY tried? 8. Equate cost with action – taxes work really well at point of sale. 9. Why would the sickcare industry have any stake in a healthier consumer? Does the oil industry… Read more »

Donald E. L. Johnson
Guest

I’m reposting to fix typos: So the questions are: 1. Who is responsible for wellness care and decision making: Providers, government, employers, consumers, all of the above, none of the above? 2. What percent of the population needs to change behavior for behaviorial change programs to be considered successful? 25% to 30% still smoke, I think. 3. Which researchers have credibility: All, some, none? 4. Can health insurance markets be tested without giving more power to politicians, employers, insurers or providers and less power to consumers? 5. What financial incentives do politicians, employers, insurers, providers and consumers need to care… Read more »

Donald E. L. Johnson
Guest

So the questions are: 1. Who is responsible for wellness care and decision making” Providers, government, employers, consumers, all of the above, none of the above? 2. What percent of the population needs to change behavior for behaviorial change programs to be considered? 25% to 30% still smoke, I think. 3. Which researchers have credibility: All, some, none? 4. Can health insurance markets be tested without giving more power to politicians, employers, insurers, providers and less to consumers? 5. What financial incentives do politicians, employers, insurers, providers and consumers to care about healthy lifestyles? Why? 6. What are the cost/benefit… Read more »

jd
Guest
jd

In case it wasn’t clear, in the last paragraph I was discussing what employers think about when choosing health benefits.

jd
Guest
jd

Some lessons from actually trying to get people to change behavior from a population standpoint (as opposed to one-on-one). Money matters, but human psychology is not that of homo economicus posited by classical economics. If you don’t know Kahneman and Tversky and the burgeoning field of prospect theory, then you do more harm than good when you talk about consumerist vs. state-sponsored solutions. To give one example: a small incentive at regular intervals for doing things like taking health risk assessments and keeping your cholesterol below a certain level make far more of an impact than simply giving people “skin… Read more »

matt
Guest
matt

There is a significant portion of the population that doesn’t respond to rational information, be it about health choices, food, auto purchases, political candidates, etc, etc. They’re simply not rational actors. There are hundreds of thousands of cars that Consumer Reports rates with one star that are sold in the US every year. That doesn’t mean that irrational, disenagaged consumers won’t respond to anything. It’s the difference between marketing “Vitamin Water” on its nutritional benefits and having 50 Cent Rap about it. The “big mistake” that plans and other make, though (and Jeff hit on this with his discussion of… Read more »

Peter
Guest
Peter

“When they become sick and need good medical decision making, they are in no condition to select providers or make critical medical decisions, at least not while they are in the initial stages of dealing with an illness or accident.” And that’s exactly the time when you find out if the insurance policy/company you bought actually looks as good and performs a well as described by the salesman/broker/brochures/web site you bought it from. It’s also the time you see how well the fine print clauses (that you never read or understood) work for the insurance company and if you can… Read more »

Donald E. L. Johnson
Guest

What the studies show is that there can be no one solution for all. Some consumers want to be involved in medical decision making and in selecting providers. Most don’t want to be or just don’t have the expertise. Years ago there was a study that said 37% of patients are self-empowered when it comes to medical decision making, which is more pertinent, I think, than choosing physicians and hospitals. What the study doesn’t address is how consumers might be empowered to choose insurers, which is what they are most qualified to do. Not only are consumers more likely to… Read more »