Beyond consumer-driven health care: purchasers' expectations of all plans

Skyrocketing health care costs and quality deficits can only be addressed through a broad approach of quality-based benefit design. Consumer-directed health plans that are built around better consumer information tools and support hold the promise of consumer engagement, but purchasers expect these features in all types of health plans. Regardless of plan type, simply shifting costs to consumers is a threat to access and adherence to evidence-based medicine. Comparative and interactive consumer information tools, coupled with provider performance transparency and payment reform, are needed to advance accountability and support consumers in getting the right care at the right time.     

Switching HMO providers. Dissatisfaction with emergency access cited as the primary reason for disenrollment

The reasons consumers choose one service provider over another are not necessarily the same as the reasons for changing service providers. The distinctions may be even more important when the service in question is health care, specifically the decision to reenroll or switch HMO providers. The authors undertook a consumer survey to gauge the importance of 41 variables in the decision process. Using logistic regression analysis, they concluded that variables associated with access to emergency care services had the greatest impact on decisions to switch. This is contrary to other studies, which have ranked emergency care access much lower, and additional research is recommended.     

The Effects of the Internet on Pharmaceutical Consumers and Providers

The Internet has changed healthcare practice and has just begun to influence pharmaceutical consumers and providers. The Internet firstly affects the pharmaceutical consumer through the five main functions it offers to all consumers of care. These functions are: (i) to provide and distribute information; (ii) to support informed decision making; (iii) to promote health; (iv) to provide a means for information exchange and support (the community concept) and; (v) to increase self care and manage the demand for health services, thus, lowering direct medical costs. Secondly, the Internet influences the pharmaceutical consumer by enhancing the move to consumer empowerment. Thirdly, it offers increased self-care capabilities to consumers through pharmaceutical information gathering and pharmaceutical products and services purchasing using Internet pharmacies. Finally, the Internet affects the pharmaceutical consumer by enhancing efficiency in the medical management of patients.It does this by providing the means for telemedicine and telepharmacy, by changing the healthcare professional-patient relationship, and by providing a tool for registering adverse drug events. Disease management benefits include: (i) access to care for remotely located consumers; (ii) the possibility of peer consultation and of access to diagnostic and therapeutic Internet information for healthcare providers; and (iii) continuity of care via virtual community networks, integrated health systems, interconnected, real-time, virtual healthcare teams, and virtual unified electronic health records. The Internet’s effect of increasing knowledge of illicit and unregulated drugs, which may change drug use behavior and drug culture, though, makes the medical management of patients less efficient.The effects of the Internet on the pharmaceutical provider firstly relate to technological and managerial changes. The Internet, secondly, induces changes in the provision of pharmaceutical care by offering the means for telemedicine, telepharmacy, and e-commerce, for advertising, promotion, and communication with consumers, and for supporting drug safety and pharmacovigilance.The Internet’s positive influence on pharmaceutical consumers and providers, however, mainly will depend on whether proper solutions can be found for the privacy/security and confidentiality problems existing in pharmaceutical information gathering and pharmaceutical products and services purchasing. Special focus should be placed on ensuring the privacy of consumer information and on the secure transmission of financial information. The best defenses will be adequate, national, international, and global laws and regulations which ensure privacy/security and confidentiality on a global level.     

Development of a Quality Ranking Model for Home Health Care Providers

This research aims to increase transparency and simplify consumer decision-making regarding the selection of a home health care provider. Currently, quality information on home health care providers is fragmented and difficult to interpret. In this study, a quality-ranking model is developed by selecting multidimensional quality indicators across multiple sources and respective weights using expert judgment. Given the weights and providers' performance on each quality indicator, a composite score is calculated that summarizes a home health care provider's overall quality level. This quality information empowers consumers to narrow their search and select the best-performing, most efficient providers.     

Patients meet technology: the newest in patient-centered care initiatives

In recent years, health care consumers have become increasingly sophisticated in their selection and use of health care services. Empowered initially by the Internet, they are seeking medical information to become better informed as they interact with physicians and other health care providers. This article addresses (1) the new patient-provider relationship with more provider accountability, the impact of Baby Boomers on health care, and the evolving consumer-driven marketplace with emerging patient-centered care; (2) emerging technologies being used to transform the patient experience; (3) how the use of cutting-edge technologies affect the health care consumer; and (4) the future impact of the use of patient-centered technology initiatives on the health care industry. The personal health record is predicted by experts to be the primary technology that will promote advancement of the electronic health record; therefore, this article focuses on patients' use of the personal health record.     

Can High Quality Overcome Consumer Resistance to Restricted Provider Access? Evidence from a Health Plan Choice Experiment

OBJECTIVE: To investigate the impact of quality information on the willingness of consumers to enroll in health plans that restrict provider access. DATA SOURCES AND SETTING: A survey administered to respondents between the ages of 25 and 64 in the West Los Angeles area with private health insurance. STUDY DESIGN: An experimental approach is used to measure the effect of variation in provider network features and information about the quality of network physicians on hypothetical plan choices. Conditional logit models are used to analyze the experimental choice data. Next, choice model parameter estimates are used to simulate the impact of changes in plan features on the market shares of competing health plans and to calculate the quality level required to make consumers indifferent to changes in provider access. PRINCIPAL FINDINGS: The presence of quality information reduced the importance of provider network features in plan choices as hypothesized. However, there were not statistically meaningful differences by type of quality measure (i.e., consumer assessed versus expert assessed). The results imply that large quality differences are required to make consumers indifferent to changes in provider access. The impact of quality on plan choices depended more on the particular measure and less on the type of measure. Quality ratings based on the proportion of survey respondents "extremely satisfied with results of care" had the greatest impact on plan choice while the proportion of network doctors "affiliated with university medical centers" had the least. Other consumer and expert assessed measures had more comparable effects. CONCLUSIONS: Overall the results provide empirical evidence that consumers are willing to trade high quality for restrictions on provider access. This willingness to trade implies that relatively small plans that place restrictions on provider access can successfully compete against less restrictive plans when they can demonstrate high quality. However, the results of this study suggest that in many cases, the level of quality required for consumers to accept access restrictions may be so high as to be unattainable. The results provide empirical support for the current focus of decision support efforts on consumer assessed quality measures. At the same time, however, the results suggest that consumers would also value quality measures based on expert assessments. This finding is relevant given the lack of comparative quality information based on expert judgment and research suggesting that consumers have apprehensions about their ability to meaningfully interpret performance-based quality measures.     

Consumer channeling by health insurers: natural experiments with preferred providers in the Dutch pharmacy market

Consumer channeling is an important element in the insurer-provider bargaining process. Health insurers can influence provider choice by offering insurance contracts with restricted provider networks. Alternatively, they can offer contracts with unrestricted access and use incentives to motivate consumers to visit preferred providers. Little is known, however, about the effectiveness of this alternative strategy of consumer channeling. Using data from two natural experiments in the Dutch pharmacy market, we examine how consumers respond to incentives used by health insurers to influence their choice of provider. We find that consumers are sensitive to rather small incentives and that temporary incentives may sort a long-term effect on provider choice. In addition, we find that both consumer and provider characteristics determine whether consumers are willing to switch to preferred pharmacies.     

Regulating India's health services: To what end? What future?

India has a comprehensive legal and regulatory framework and large public health delivery system which are disconnected from the realities of health care delivery and financing for most Indians. In reviewing the current bureaucratic approach to regulation, we find an extensive set of rules and procedures, though we argue it has failed in three critical ways, namely to (1) protect the interests of vulnerable groups; (2) demonstrate how health financing meets the public interests; (3) generate the trust of providers and the public. The paper reviews the state of alternative approaches to regulation of health services in India, using consumer and market based approaches, as well as multi-actor and collaborative approaches. We argue that poor regulation is a symptom of poor governance and that simply creating and enforcing the rules will continue to have limited effects. Rather than advocate for better implementation and expansion of the current bureaucratic approach, where Ministries of Health focus on their roles as inspectorate and provider, we propose that India's future health system is more likely to achieve its goals through greater attention to consumer and other market oriented approaches, and through collaborative mechanisms that enhance accountability. Civil society organizations, the media, and provider organizations can play more active parts in disclosing and using information on the use of health resources and the performance of public and private providers. The overview of the health sector would be more effective, if Indian Ministries of Health were to actively facilitate participation of these key stakeholders and the use of information.     

Consumers' and providers' responses to public cost reports, and how to raise the likelihood of achieving desired results

There is tremendous interest in different approaches to slowing the rise in US per capita health spending. One approach is to publicly report on a provider's costs--also called efficiency, resource use, or value measures--with the hope that consumers will select lower-cost providers and providers will be encouraged to decrease spending. In this paper we explain why we believe that many current cost-profiling efforts are unlikely to have this intended effect. One of the reasons is that many consumers believe that more care is better and that higher-cost providers are higher-quality providers, so giving them information that some providers are lower cost may have the perverse effect of deterring them from accessing these providers. We suggest changes that can be made to content and design of public cost reports to increase the intended consumer and provider response.     

Assessing the Utility of Consumer Surveys for Improving the Quality of Behavioral Health Care Services

The development and implementation of provider performance and consumer outcome measures for behavioral health care have been growing over the last decade, presumably because they are useful tools for improving service quality. However, the extent to which providers have successfully used performance measurement results has not been adequately determined. To this end, two methods were used to better understand the use of data obtained from an annual survey of behavioral health care consumers: a cross-sectional survey of executive directors, clinical program directors, and quality improvement directors and follow-up interviews with a subsample of survey respondents. Results revealed information about the use of consumer survey data, factors that facilitate and hinder the use of results, as well as respondents?? opinions about consumer survey administration procedures. These findings provide valuable information for the application of performance measures and, ultimately, improving consumer outcomes.     

Do health and medical workforce shortages explain the lower rate of rural consumers' complaints to Victoria's Health Services Commissioner?

OBJECTIVE: To identify which explanations account for lower rural rates of complaint about health services--(i) fear of consequences where there is little choice of alternative provider; (ii) a higher complaint threshold for rural consumers; (iii) lack of access to complaint mechanisms; or (iv) reduced access to services about which to complain. DESIGN: Ecological study incorporating consumer complaint, population and workforce distribution data sources. SETTING: All health care providers practising in Victoria. PARTICIPANTS: De-identified records of all closed consumer complaints made to the Health Services Commissioner, Victoria, between March 1988 and April 2001 by Victorian residents (13 856 records). MAIN OUTCOME MEASURES: Differences in the percentage of under-representation in complaint rates in total and for each of four categories of health services providers for different size communities. RESULTS: No consistent relationship was observed between community size and either degree of under-representation of complaints against any category of provider, or the proportion of serious or substantial complaints. Rural under-representation was highest (41%) for dentists, the provider category with the lowest proportion working in rural areas (17%), and lowest (18%) for hospitals, with the highest representation in rural areas (28% of beds). More rural complaints were about access issues (10.7% rural and 8.4% metropolitan). CONCLUSIONS: Reduced opportunity to use health services due to rural health and medical workforce shortages was the best-supported explanation for the lower rural complaint rate. Workforce shortages impact on the quality of rural health services and on residents' opportunities to improve their health status.     

Selecting a provider: what factors influence patients' decision making?

Each year consumers make a variety of decisions relating to their healthcare. Some experts argue that stronger consumer engagement in decisions about where to obtain medical care is an important mechanism for improving efficiency in healthcare delivery and financing. Consumers' ability and motivation to become more active decision makers are affected by several factors, including financial incentives and access to information. This study investigates the set of factors that consumers consider when selecting a provider, including attributes of the provider and the care experience and the reputation of the provider. Additionally, the study evaluates consumers awareness and use of formal sources of provider selection information. Our results from analyzing data from a survey of 467 patients at four clinics in Minnesota suggest that the factors considered of greatest importance include reputation of the physician and reputation of the healthcare organization. Contractual and logistical factors also play a role, with respondents highlighting the importance of seeing a provider affiliated with their health plan and appointment availability. Few respondents indicated that advertisements or formal sources of quality information affected their decision making. The key implication for provider organizations is to carefully manage referral sources to ensure that they consistently meet the needs of referrers. Excellent service to existing patients and to the network of referring physicians yields patient and referrer satisfaction that is critical to attracting new patients. Finally, organizations more generally may want to explore the capabilities of new media and social networking sites for building reputation.     

Transaction costs of access to health care: Implications of the care-seeking pathways of tuberculosis patients for health system governance in Nigeria

Health care costs incurred prior to the appropriate patient–provider transaction (i.e., transaction costs of access to health care) are potential barriers to accessing health care in low- and middle-income countries. This paper explores these transaction costs and their implications for health system governance through a cross-sectional survey of adult patients who received their first diagnosis of pulmonary tuberculosis (TB) at the three designated secondary health centres for TB care in Ebonyi State, Nigeria. The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider. Of the 452 patients, 84% first consulted an inappropriate provider. Only 33% of inappropriate consultations were with qualified providers (QP); the rest were with informal providers such as pharmacy providers (PPs; 57%) and traditional providers (TP; 10%). Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70). These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers.     

Expanding Internet access for health care consumers.

Sophisticated health care consumers are beginning to use the Internet to educate themselves about their own health and manage their own care. As health care stakeholders (providers, payers, employers) feel pressure from consumers to implement Internet-related strategies, stakeholders must realize that obtaining Internet access is a challenge for many consumers. Stakeholders who expand consumer Internet access will, however, have a competitive advantage. This article outlines how stakeholders can expand consumer Internet access.     

Making the Most of Web Resources to Enhance Health Disparities Information Programs

Abstract

Libraries have the ability to create significant programs for populations most affected by health disparities. Increasing Web-based health resources is transcending the availability of consumer health information. Reliable information is critical to making informed health care decisions. Library services for targeted populations can provide substantial benefits for health information consumers. To date, several libraries have implemented consumer focused health information programs. Although valuable, such programs do not exist without challenges to both consumers and program providers. This article explores consumer focused program models and primary barriers faced by librarians who carry out health information programs. Finally, the authors recommend ideal information tools and Web-based health resources to enhance consumer focused health disparities information programs.     

Consumers’ interpretation and use of comparative information on the quality of health care: the effect of presentation approaches

Background Public reports about health‐care quality have not been effectively used by consumers thus far. A possible explanation is inadequate presentation of the information. Objective To assess which presentation features contribute to consumers’ correct interpretation and effective use of comparative health‐care quality information and to examine the influence of consumer characteristics. Design Fictitious Consumer Quality Index (CQI) data on home care quality were used to construct experimental presentation formats of comparative information. These formats were selected using conjoint analysis methodology. We used multilevel regression analysis to investigate the effects of presenting bar charts and star ratings, ordering of the data, type of stars, number of stars and inclusion of a global rating. Setting and participants Data were collected during 2 weeks of online questioning of 438 members of an online access panel. Results Both presentation features and consumer characteristics (age and education) significantly affected consumers’ responses. Formats using combinations of bar charts and stars, three stars, an alphabetical ordering of providers and no inclusion of a global rating supported consumers. The effects of the presentation features differed across the outcome variables. Conclusions Comparative information on the quality of home care is complex for consumers. Although our findings derive from an experimental situation, they provide several suggestions for optimizing the information on the Internet. More research is needed to further unravel the effects of presentation formats on consumer decision making in health care.     

Assessment of cost sharing in the Pima County Marketplace

The Patient Protection and Affordable Care Act established health insurance marketplaces to allow consumers to make educated decisions about their health care coverage. During the first open enrollment period in 2013, the federally facilitated marketplace in Pima County, Arizona listed 119 plans, making it one of the most competitive markets in the country. This study compares these plans based on differences in consumer cost sharing, including deductibles, co-pays and premiums. Consumer costs were reviewed using specific cases including a normal delivery pregnancy, the management of Type II Diabetes, and the utilization of specialty drugs to treat Hepatitis C. Total cost of care was calculated as the cost of managing the condition or event plus the cost of monthly premiums, evaluated as a single individual age 27. Evaluating a plan on premium alone is not sufficient as cost sharing can dramatically raise the cost of care. A rating system and better cost transparency tools could provider easier access to pertinent information for consumers.     

Between Two Worlds: The Use of Traditional and Western Health Services by Chinese Immigrants

This study examined the use of traditional and Western health services by Chinese immigrants, as well as the cultural and socioeconomic factors affecting health-seeking behaviors and health service utilization patterns among the study population from the perspectives of consumers and Chinese health care providers. Two instruments were used for data collection. The first, a consumer instrument, was designed for interviews of service recipients; the second, a health provider instrument, was designed to elicit information from traditional and Western providers. A few topics in the former instrument were cross-examined from the perspectives of health care providers. The investigation employed a combination of qualitative and quantitative research methods for data collection. Qualitative ethnographic methods used included: (1) participant-observation, (2) face-to-face interview, and (3) case study. To complement the qualitative data, structured quantitative survey were conducted with all selected informants. A total of 105 informants participated in the study: 75 Chinese consumers and 30 Chinese health professionals. The latter group was composed of Western physicians and traditional practitioners. Results revealed several patterns of health-seeking and service utilization behaviors among the Chinese of Houston and Los Angeles. These included high rates of self-treatment and home remedies (balanced diets and other alternative medicines); medium rates of utilization of integrated Western and traditional health services, including travel to country of origin for care; and low rates of exclusive utilization of Western or traditional Chinese treatments.