How providers' messages about cost and quality are worded can significantly affect how they are interpreted, research shows. "You need to know how to convey price and quality information in a way that [doesn't] cause unintended effects," says a researcher.
When it comes to consumer goods, the perceived link between cost and quality is usually pretty clear.
But when it comes to healthcare, the link is less clear.
Phillips is lead author of a study in Health Affairs that found that most consumers don't believe there's an association between healthcare cost and quality.
People who had already compared prices, however, were more likely to perceive that price and quality were associated than those who hadn't, the study found. Also, a significant minority do believe there's an association between cost and quality, while others aren't sure.
The study analyzed data from a nationally representative survey of more than 2,000 adults conducted by Public Agenda with funding from the Robert Wood Johnson Foundation. Among the questions asked:
Would you say higher prices are typically a sign of higher quality medical care or not?
- 71% said NO
- 21% said YES
- 8% said DON'T KNOW
Would you say lower prices are typically a sign of lower quality medical care or not?
- 63% said NO
- 22% said YES
- 14% said DON'T KNOW
The wording of the questions influenced the respondents' perceptions, suggesting that an understanding of behavioral economics could help providers shape and strengthen their messaging:
If one doctor charged more than another doctor for the same service, would you think that the more expensive doctor is providing higher quality care, or would you not think that?
- 67% said NO
- 23% said YES
- 9% said DON'T KNOW
If one doctor charged less than another doctor for the same service, would you think that the less expensive doctor is providing lower quality care, or would you not think that?
- 58% said NO;
- 24% said YES
- 16% said DON'T KNOW
"We were surprised that people perceived high price and high quality differently than low price and low quality, although that's what behavioral economics would predict," Phillips says.
She says that the results of this study have several implications, especially for those who are attempting to educate consumers about healthcare pricing.
Takeaways for Providers
In an effort to be more transparent and to be part of the consumer-driven healthcare movement, many hospitals and other healthcare organizations are providing cost information to consumers. But the study suggests that a "data dump" approach to developing cost transparency tools isn't the best path forward and could actually have some negative consequences.
"You need to know how to convey price and quality information in a way that consumers can use it, and you don't want to cause unintended effects," Phillips says.
For instance, consumers might perceive lower-priced care as lower-quality care, and choose care that's more expensive for that reason.
"You have to use that in such a way that you're conveying information in the intended way," Phillips says. "You can't just put information out there and assume that it will be used in the way you're hoping and perceived in the way you're hoping. It's much more complex than that."
Also, the elements that make high-quality healthcare aren't always clear to consumers.
"There's variability in what consumers perceive as quality," Phillips says, noting that people often measure it based on what they can see and experience such as whether the doctor is nice to them. For instance, another study in the same Health Affairs issue found that Yelp reviews of hospitals include 12 additional categories that aren't included in or are not covered by the HCAHPS survey:
- Cost of hospital visit
- Insurance
- Billing
- Ancillary testing
- Facilities, amenities
- Scheduling
- Compassion of staff
- Family member care
- Quality of nursing
- Quality of staff
- Quality of technical aspects of care
- Specific type of medical care
"It's difficult to convey quality information to consumers," she says. "If you're going to give them price information, you have to give them some idea of quality. The two go together."
Phillips also says people developing these tools should draw from existing knowledge about how people use information and make decisions.
"Different people pay more attention to certain things," she says. "We want a consumer-driven healthcare system that meets what people want, and people do want price information. They're just not sure what to do with it."
Alexandra Wilson Pecci is an editor for HealthLeaders.
