Health care consumerism is an important and rising trend in health care. Yet, a new study in Health Affairs has thrown a dose of harsh reality into the expectation that we are on the verge of shifting to a consumer-driven marketplace in health care.

The study, which was conducted among close to 3,000 non-elderly Americans, showed that most people are supportive of the concept of price shopping, but very few price shop themselves. Only 13 percent of respondents who had some out-of-pocket spending in their last health care encounter had sought information about their expected spending before receiving care, and just 3 percent had compared costs across providers before receiving care. 

In other words, consumer-directed health care is only in its infancy, despite all the talk about this rising trend.

Fundamental barriers

There are several fundamental barriers that prevent this trend from taking more hold:

  • Lack of transparency: Consumers generally have very little, if any, information about what they will be asked to pay for a doctor visit or a procedure before these take place.
  • Complexity: Take a look at the invoices that providers or laboratories provide. They are very hard to understand and not at all consumer friendly. Shopping among health insurers for the best and most affordable plan is also extremely challenging.
  • Trust in provider: According to the study in Health Affairs, most people don't compare the costs of providers they have a previous relationship with. They are more likely to check costs if they seek a new provider.
  • Mindset: When you are sick, suffering from a severe chronic disease or needing acute care, most people are not like to do price shopping.
  • Third-party payment: The most fundamental barrier is that out-of-pocket payment, despite rising in size, still represents a smaller portion of the entire health care bill, and consumers don't pay the bill themselves, their insurer or employer does. As long as somebody else pays for the service, a consumer is less likely to make price comparisons before receiving the care.

In summary, health care is not like any other consumer experience. Shopping for health care will never be the same as when you shop for a new car, an airline ticket or a new washing machine.

Mediated health care consumerism

Despite these barriers, health care consumerism is an important trend that impacts the quality of health care, and the costs of health care delivery in the future. With growing out-of-pocket costs, higher deductibles of health plans, and the rise of more educated, assertive generations of consumers with access to digital tools, this trend will continue.

But rather than looking at health care as a traditional consumer market, it is more productive to approach health care consumerism as a mediated phenomenon, as a driving force for all the stakeholders that surround the patient/consumer in the complete health care equation: physicians and other health care professionals, providers, hospitals, health systems and payers/insurers.

There is an abundance of data showing that educated, engaged and active consumers are healthier, manage their chronic diseases better and recover more quickly from procedures. Providers, hospitals and health systems also realize that enhancing the quality of the patient experience is critical to improving clinical outcomes, reducing costs and elevating their reputation. As an example, Geisinger Health System refunds money to patients who have reported a poor health care experience.

Health care organizations that understand the power of mediated health care consumerism and find ways to offer more transparency around the quality and costs of their care, engage patients in their own care and enhance the quality of the patient experience, will be most successful in an increasingly competitive marketplace.

 

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Stig Albinus

Stig Albinus is a senior director in APCO Worldwide’s global health care practice. Read More