Self-Pay Markets In Health Care: Consumer Nirvana Or Caveat Emptor?

Abstract

As consumers face more incentives to make cost-conscious medical care decisions, some policymakers cite self-pay markets as models for consumer shopping. An analysis of the LASIK market revealed limited shopping overall, despite the fact that patients pay the full cost. For other self-pay procedures, consumers shop even less, for reasons ranging from urgency, to costs of obtaining price quotes, to quality concerns that prompt many consumers to rely on word-of-mouth recommendations. Given that consumer shopping is not prevalent in most self-pay markets, we expect the extent of shopping to be even more limited for many services covered by insurance. [Health Affairs 26, no. 2 (2007):

Demand-Driven Care and Hospital Choice. Dutch Health Policy Toward Demand-Driven Care: Results from a Survey into Hospital Choice

“…Now that the gap between the assumptions of demand-driven health care and reality is recognized, measures are being proposed to deal with it. Some suggest that the answer is to educate patients as to how to shop for health care and use performance data [59]. However, our multivariate analysis found that education alone does not mold patients into rational consumers.…”

“…Right from the beginning of hospital certification in the U.S., JCAHO (The Joint commission on Accreditation of Healthcare Organizations) charged a fee for it [62]. This has continued to be a barrier for patients seeking quality information; fees have even increased over time [59]. Two important organizations that rate hospital performance in the U.S., NCQA (National Committee for Quality Assurance) and Healthgrades make minimal information available to consumers for free and charge several thousand dollars for detailed report cards.…”

“…If this were true, it might help control health care costs, but there is little evidence that, even when price is available, it is employed in choosing a hospital [59]. Still, one study found that consumers were more interested in the price and benefits package than health care performance measures [60].…”

“…Patients also prefer the hospital that they are ''familiar with'' over the hospital with a higher quality rating [22]. Some researchers suggest that even in the best of circumstances, when the medical procedure is not urgent (for example Lasik eye surgery), advice from trusted friends is given greater weight in health care decision making than performance data [1,59]. Friends, peers, and family are preferred sources of information because performance data seems impersonal [9,21,64].…”

The Failure of Mandated Disclosures, part 3

“…Пациенты восприни-мают метод лазерной коррекции зрения как товар и выбирают клинику, руководствуясь только стои-мостью, хотя качество операции сильно отличается в различных клиниках [144] 52 . Кроме того, уверен-ность в себе заставляет людей переоценивать свои знания.…”