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Health Plan Restraints Might Keep Patients From Choosing Quality Care

Ruzanna Harutyunyan's picture

Public reports on the quality of care delivered by health plans might motivate patients to choose better providers — if they are not constrained by issues of cost and accessibility to doctors, according to a review of recent studies.

The findings, published in the January 2009 issue of Medical Care, shed some light on the puzzle of why people repeatedly say they are interested in quality when it comes to health care, but rarely make it a priority when they choose their providers.

In real-life situations, when individuals were choosing a new health care plan, fewer than 5 percent said that quality information had influenced their choice of health care provider, said lead author Marjan Faber, Ph.D. She was with the Centre for Quality of Care Research when the study was conducted.

Faber and colleagues analyzed 14 studies, all conducted in the United States.

Cost and physician choice “clearly influence the weight given to quality information within a health plan setting,” Faber said.

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In particular, features such as premiums, out-of-pocket costs, the ability to keep one’s own doctor and customer service all compete with quality information when it comes to choosing a provider, according to the researchers.

In most of the studies, quality data came from the Consumer Assessment of Health care Providers and Systems (CAHPS) program, a public-private initiative led by the U.S. Agency for Healthcare Quality and Research that collects information from a variety of surveys of patient care.

Ten studies asked patients about quality data in a hypothetical, laboratory setting; while the other four studies focused on how new Medicaid patients used the CAHPS information to choose a health plan in real-world situations.

Patients seem to be more sensitive to quality of care information if they are dissatisfied with their current provider, newly diagnosed with a specific condition, or choosing a new health insurance plan, the researchers found.

However, most people do not have a lot of time to research new plans, and “many consumers in the U.S. are increasingly constrained by reductions in health plan options and the benefits covered,” said Faber, who is now with the Scientific Institute for Quality of Healthcare.

Across all studies, the researchers found that the presentation of the quality data — and its readability — made a significant difference in whether people used or ignored the data.

Judith Hibbard, Dr.P.H., an expert in public reporting of health data at the University of Oregon, said that many patients have a difficult time wading through the unfamiliar numbers and less user-friendly formats of some quality reports. “Until we make these compelling to consumers, we’re not going to have the improvements in quality,” she said.