Choices

CHW LogoThe first time I saw a TV ad for a prescription medication (direct-to-consumer advertising was made legal in 1985), I was appalled.  Not only because of the long list of potential side effects – which as I recall included both flatulence and death) – but the whole concept that companies would try to market something as complex as a drug the same way they would treat floor wax or breakfast cereal.   Health care is not a consumer good!

Well, it’s become clear that health care is, in fact, a consumer good, and those of us who provide health care need to accept that and understand how consumers make decisions about it.  Even when we grudgingly admit that people may be doing some “shopping” for their medical care, we tend to think that health care is still very different.  In some ways that is certainly true.  For example, measuring and reporting on quality is far more challenging in health care.  And there is considerably less ability for consumers to get information on medical cost than for almost any other product or service.  But as a 2015 McKinsey study showed, the factors used by consumers to rate health care and non-health care companies are nearly identical: the top 4 were (in order) customer service, “delivering on expectations,” convenience, and “offering great value.”

It may be that these other factors are merely proxies for actual quality measures.  As noted in a Deloitte report:

Quality tends to be defined with professionals in mind. In lieu of understanding clinical quality, consumers may substitute cost, convenience, and customer experience for quality. Consumers may well equate quality with cost, assuming a direct relationship between the two.

Certainly, health providers like to think that when it comes to picking a doctor or hospital, quality is most important and trumps everything else.  But maybe not so much.  Another McKinsey study found that although patients stated that clinical outcome was most important to them, experience was actually more highly correlated with willingness to choose that provider again.  And cost is increasingly a factor.  In a 2015 survey by FAIR Health, 48% of all respondents indicated they always or usually considered cost when selecting a doctor.  And despite a widespread belief that cost is no barrier when it comes to health care for children, it actually appears to be more important for the generation with kids.  In this survey, cost was more often cited as a key factor for those age 18-44 (58%), those with children (56%), and women (53%).

We can wish away consumerism (and TV ads).  Or we can deal with it.  That doesn’t mean sacrificing quality.  We need to maintain our commitment to the best and safest care.  At the same time, we also need to address families’ real concerns about cost, convenience, and experience.  It starts with one element of our service promise: “I will strive to understand what matters most to you.”  If we don’t know what consumers value, we can’t provide it, or help them navigate the choices they must make.

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