Savior
Who will be the savior of healthcare? Many point to technology, meaning computers, and there is no doubt that healthcare is behind other industries in tapping the benefits of IT. However, to believe that IT will bring about a sea change in healthcare costs or quality demonstrates a lack of understanding of this tool. Things will improve, at some cost, but the difference will not be dramatic.
Transparency is the new God. Well, actually not new but resurrected--something that Gods do. The thought is that if the finances of healthcare are transparent to patients, they will make choices based on the market value of the services provided--the cost/quality equation. This works well in other industries, tho better with things than services--particularly personal services. Do you shop for price for a lawyer? Tax accountant? Baby-sitter? Well, maybe, a little, but reputation and personality trump cost at the margins.
The Commonwealth Fund has published several papers on the subject and recently published a “Survey of Opinion Leaders” on the subject of transparency. Respondents were primarily academics and administrators (n = 241), and the results are published in a series of charts. Here are some highlights:
Figure 2: Most think transparency will have little effect on price (<5%), tho business leaders were more positive about this than academics.
Figure 3: 82% felt that transparency efforts should be focused on “clinical quality” (the technical aspect of healthcare) and only 53% voted for the “patient experience” (the service aspect). Price came in last at 38%. These numbers probably reflect the bias of the respondents and demonstrate a lack of interest in the rising cost of healthcare.
Figure 4: “Objectives of Enhanced Transparency on Quality and Price” did not mention price or cost in the list.
Figure 5: How likely are consumers to use price and quality data in their decisions? 53% = Not Likely, 35% Somewhat Likely. Wonder why a system that works so well with automobiles won't work in healthcare. Could it be that “HC Opinion Leaders” don’t want that to be true? Or is this the vestige of paternalism, “Patients aren’t capable of understanding the data and can’t make intelligent decisions.”
And, of course, everyone thinks everyone else should help pay for collection of data, and everyone thinks “technology” will be the magic bullet to achieve transparency (rather than an implementation tool). Finally, if you have an idea you believe in (transparency), you want all the presidential candidates to come out in favor of it.
Robert Galvin MD (a board member of CMWF) supports the notion that bad data is better than no data--a fact that Andrew Cuomo recently learned. Pretty good data is OK with consumers in the absence of something better. He also notes the plethora of meaningless data (% of patients admitted with chest pain who get an EKG) while standards organizations ignore data that would be more meaningful to patients, like “how long do I have to wait?”
In another commentary on the CMWF website, Paul Ginsburg makes several good points about healthcare markets:
Hospital charge data are not terribly useful. Our system of charging for hospital services is bizarre at best. Charges bear no resemblance to what insurers pay, and patients who pay are charged more than insurance companies. And don’t try to offer discounts, or Medicare will put you in jail.
Some needs are too urgent or too complex to allow comparison shopping. As he points out, 10% of people account for 70% of spending, and these patients have little/no incentive or ability to economize. True, but most healthcare encounters are routine and amenable to choice, if only there were a basis for choice. If there were price pressure on these few encounters, perhaps the cost reductions would spread to the remaining 70% of spending.
Insurance has diluted incentives to consider price. If someone else is paying the bill, why would anyone care about cost? This is less true in the US than in the rest of the world (we pay more of our healthcare bill), but the mentality persists.
There are benefits to choosing providers that provide better value. In this, he defines value as a mix of cost and quality.
He also reflects a common theme that insurers should be the agent for consumers. In one sense, they are--but only if you limit “consumer” to the company that purchases the insurance, not the patient. Provider networks are usually chosen for providing the lowest price to the insurance company, not the best value to the patient.
Bottom line: Would transparency make healthcare more efficient? Well, maybe, but not all by itself.
