American College of Physicians: Internal Medicine — Doctors for Adults ®

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Consumer shun statistics when picking a health plan

From the December 1996 ACP Observer, copyright © 1996 by the American College of Physicians.

By Jennifer Fisher Wilson

WASHINGTON—Americans say that quality is their primary concern when it comes to choosing a health plan, but a new study shows that they still put more faith in the opinions of family and friends than quality measures developed by researchers.

Consumers tend to view anecdotal information—the opinions of others, for example—as indicators of quality more than less accessible statistical quality indicators such as immunization rates or the use of preventive services like mammography, according to the results of a telephone survey by the Kaiser Family Foundation and the Agency for Health Care Policy and Research (AHCPR).

"This survey confirms what we've all heard: Quality is important," Clifton R. Gaus, AHCPR administrator, said at a conference organized to discuss the implications of the survey. But the quality of care provided by health plans is not yet widely available information, and consumers often don't know how to interpret what little information is available.

Only 39% of respondents said they had seen data comparing the quality of health plans in the last year, and even fewer—34%—used the information in their own decision making. Nine out of 10 of the approximately 2,000 respondents thought that such information would be useful when making a health care decision, but almost half said their employer offered only one plan, giving them little reason to use comparative information.

But relying chiefly on anecdotal recommendations for choosing a plan can be risky. It's what consumers don't learn that can most affect their care. "Most consumers don't understand the structural differences among the plans or the effects on care delivery," said Diane Archer, JD, the executive director of the Medicare Rights Center. Consumers are not given the whole story from health plans, which advertise their availability of services without mentioning any constraints on accessing those services, she said. As a result, consumers discover their plans' constraints only when they or someone they know face problems accessing care.

More meaningful and easily understood health care data will help consumers become more sophisticated in decision making, according to Soshanna Sofaer, Dr.P.H, the director of the Center for Health Outcomes Improvement Research at George Washington University. By having more complete information, she said, consumers will feel more confident in the health system and learn how to better use it to fulfill their needs.

Until that time, however, Americans are looking to the government to safeguard their rights as health care consumers. Perhaps because they recognize they don't really understand today's health care system, Dr. Smith said, 88% of the survey respondents said the government should have a role in ensuring the quality of health care.

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