On Health Care, We Need More and Better Information and Deliberation
by Thomas Workman, Ph.D.
This commentary offers reflection on the findings and implications from "Curbing Health Care Costs: Are Citizens Ready to Wrestle with Tough Choices?" Thomas Workman is the Principal Communication Researcher and Evaluator in the Health Program at the American Institutes for Research, where he leads its Center for Patient and Consumer Engagement.
As is evident in "Curbing Health Care Costs: Are Citizens Ready to Wrestle with Tough Choices?", there are disconcerting contradictions and inconsistencies in Americans’ views on health care that indicate the need for continued public information and deliberation. Several of these contradictions are worth noting, as they may hold a key for developing successful approaches to engaging the public in policies and practices that enable quality care and controlled cost.
As the report notes in its introduction, the current cost crisis is certainly not new, yet public consciousness and a sense of urgency have begun emerging only in the past five years. The reasons are many: unlike all other consumer services, the majority of health-care costs are indirect, handled through a third-party payer. Out-of-pocket costs were historically an issue only for the poor, uninsured and underinsured. The rest of the nation remained fairly protected and blissfully unaware. But those days have passed.
Many of the findings in this study ring true with our own at the American Institutes for Research and our Center for Patient and Consumer Engagement. Recent deliberations across the country that we conducted for the Agency for Healthcare Research and Quality found similar public interest in information, a variety of perspectives and a desire for a place at the table as solutions are found and implemented. As in the deliberations we conducted, the study participants walked in with both misinformation and an individual, rather than a social, perspective on costs.
It is no wonder that health consumers, who are informed more by direct marketing than science or policy analysis about health care, indicate in this study their belief that specialists and renowned hospitals justifiably cost more. Our own 2010 study found that most consumers believed that more care, newer care, and more expensive care was better. However, this study also shows the extent to which patients understand that doctors may order too many tests and treatments because they are financially motivated to do so.
There are many encouraging signs from this study, however, that need additional fostering. Our own experience echoes the experience in this study of witnessing a shift in perspective as participants become informed, an eagerness to learn more about the issue of health-care costs, and a sense of duty in “wrestling” with the complexities of health-care costs.
These results, along with other similar findings, need to bolster the efforts now underway — funded by both federal agencies and private foundations — to engage consumers and patients in cost payment reform at a variety of levels, ranging from cost-effectiveness conversations when deciding treatment with a doctor to engagement at clinics and hospitals considering new forms of payment systems, such as bundled payments.
Critical to the effort is the need for consumers to demand that cost and quality remain on the table together. Accountable Care Organizations, Patient-Centered Medical Homes, and a variety of new models for care are seeking both reduced costs and increased quality, and many are committed to involving patients and consumers in their efforts as the ultimate end-users of their work. We can only hope that a similar spirit of engagement can be found in public policy settings. Our patients have much to add to those discussions.