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How Real is Healthcare Consumerism?

News  |  By Gregory A. Freeman  
   April 04, 2016

It’s real enough to drive changes in how the healthcare industry communicates costs and quality, but still a long way from true consumer shopping.

Consumerism has been making inroads into the healthcare industry for at least a decade, with patients increasingly acting like consumers who have a choice in their healthcare options, trying to make the best decisions for quality and cost just as they do with any other commodity. The trend has been accelerated by the Patient Protection and Affordable Care Act, which left many consumers with large deductibles that put more pressure on them to find the most cost-effective care for the dollars coming out of their own pockets.

Just a few years ago, patients seeking information about a doctor or hospital were able to find only the most basic data, leaving them to base their treatment decisions on the few factors they could mostly understand—their insurance coverage and the availability of the care they needed. Now many of those patients are able to access much more detailed information about important factors such as a physician'sexperience with a particular procedure or a hospital's complication and readmission rates.

Patients are finding, however, that there are limits to how much they can play the savvy consumer. Despite growing access to quality metrics and hospital rankings, there still are holes in that data that can make it difficult to discern meaningful differences among providers; and even if patients have adequate information, they may be unable to choose freely because of health plan restrictions and other limitations.

However, the trend toward consumerism has advanced far beyond where it was just a few years ago, and the healthcare industry is responding with outreach and initiatives intended to help patients in their quest for value.

At the same time, consumers and healthcare leaders are both realizing that making healthcare choices is not the same as finding the best deal on a television set—and it never will be. Other concerns and motivations are in play when it comes to healthcare, starting with the fact that the patient often is making the decision in a time of stress and urgent need. Also, choosing one physician or hospital usually is not enough; the patient has to make choices based in part on which physicians, specialists, and hospitals work together and how they will work with the patient's insurance coverage. And unlike most consumer choices, the human connection between the patient and the provider can hold great sway over a patient's decision.

The search for cost and quality information
Research by Healthgrades, a Denver-based online resource for consumers seeking information about physicians and hospitals, indicates significant overlap between what consumers say is most valuable when selecting a physician and what physicians want to know when referring a patient to a specialist. Both consumers and physicians say experience-related information is most important, especially for complex conditions and unique cases.

When choosing a hospital, quality measures such as complications and mortality rates are most important in complex cases. Consumers take note of the "patient satisfaction" ratings of a physician or hospital more in basic, everyday situations such as selecting a primary care provider than they do in more complex scenarios such as finding the best surgeon for the procedure they need.


Gregory A. Freeman is a contributing writer for HealthLeaders.

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