Monday, September 11, 2006

Consumer-driven? More like consumer driven nuts

…In his Capital column in the WSJ (Sept 7, 2006), David Wessel put the kibosh on the admin theory that if only everyone knew the cost of medical services and could research docs and hosps, they could make the best choices and drive the baddies out of business.

…This presupposes, Wessel says, that health care is like other businesses. (And that insurance plans will let you pick and choose.)

…For one thing, would patients go to all of the trouble to do the nearly impossible task of researching all this, if they liked their doctors and thought they were getting good care?

…Many do think this.

…But Wessel says just because patients think they are getting good care, doesn’t mean they are.

…If you like the food in a restaurant, it doesn’t matter if a restaurant reviewer agrees. Same for a car. If you like it, who cares what websites say about it? But in health care, what the experts think might be life or death for you.

…Rand asked some elderly patients at two big managed care plans about their docs. The average score was 8.9 out of 10.

…They were asked did the doctor and other providers listen to you? Did they explain things so you could understand? Oh, yes! Communication came in a 9.2.

…Some researchers went over 13 mos of records for these patients, using a standardized measure of quality.

…These same docs and providers averaged 5.2 on what they were actually doing for these people.

…Patient satisfaction surveys—much favored by health plans, for obvious reasons—do not tell the whole story.

…If these patients, for instance, didn’t know that a standard of care was for them to be offered a daily aspirin, they wouldn’t know their care wasn’t as great as they thought.

…HA has one corollary observation. To get this loyalty, these people must either believe “doctor knows best” or have extraordinarily personality-endowed physicians.

…Her main gripe—again just this week about a provider her 89-year-old mother sees—is that many of these people are personality-less and do not inspire the least bit of confidence.

…1’s out of 10.

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