Consumer Directed Health Care…Lacking Direction

A critical analysis of one community’s experience with tiered hospital networks is outlined in a recent paper published in Health Services Research. The authors describe the differences noted in patient behavior regarding admission to the hospital among employees from the same firm.

Three groups are described: (1) an engineer’s union (considered highly educated), (2) a machinist’s union (considered less educated), and (3) non-union employees. Both unions, in their employee benefits, were offered financial incentives to use hospitals that possessed higher grades in terms of “quality.” Non-union employees did not have the same incentive in their health care plan.

After a period of observation before and after institution of the incentives for utilizing higher quality hospitals, authors examined the behavior of the three groups. Only in the engineer’s union was a change in behavior noted. It appeared that neither the machinist’s union nor the non-union employees utilized higher quality facilities when hospital admission was necessary. It is important to note that the significant effects noted in the engineer’s union only applied to medical diagnosis and not to surgical diagnoses. Also, patients admitted via the emergency department were excluded from analysis – a critical decision in terms of applicability of this new data.

Comment:

While certain entities such as the “Leapfrog Group” have led the “quality” movement in healthcare, this study appears to minimize the effect such information has on patient choices. The philosophy of consumer-driven health care professes that informed “consumers” (that is, patients) will lead to better choices and less expensive, higher quality healthcare. The current study offers little support to this hypothesis. There remain too many obstacles. First, how do policy makers define quality? Secondly, how educated must a “consumer” be in order to make wise (i.e. less expensive) health care decisions? Lastly, how can a “consumer” choose to be admitted to a high quality hospital if his or her personal doctor doesn’t have admitting priveleges there? Until these questions are answered, consumer-directed health care will remain theory.

Health Services Research 43:5, Part II (October 2008): 1849-68.

by
Cedric K. Dark, MD, MPH