Is transparency valuable?

An article in today’s iHealthBeat (Value of Health Care Cost, Quality Websites Might Be Overestimated) confirms what many of us already know: websites providing data on provider cost and quality are seldom influential in determining consumer behavior. The article mentions a variety of reasons for this:

  • Price information is irrelevant for all but the uninsured. Even for the uninsured, the information is about discrete procedures rather than episodes of care
  • Sample sizes are too small to be meaningful
  • Data are sometimes unreliable
  • Information is too difficult to interpret

The author quotes a researcher from the Center for Studying Health System Change who notes that the biggest influence of these sites is likely to be on providers, who’ll use the information to spur improvements. I think that’s right.

There are some other important limitations that the article omits:

  • Data are often old, so a provider can always say that the situation has improved or that the year in question was anomalous
  • Data are reported at the level of a physician group, hospital or IPA –which a patient may feel is irrelevant compared with the specific doctor or nurse treating them
  • In many cases (certainly in Boston) it’s hard enough for a patient to find any physician to treat him or her, never mind one that’s particularly good. This is true for primary care physicians and specialists. Who cares if Doc A is better than Doc B when neither one is accepting new patients!
  • Consumers rightly believe that factors other than the ones included in the ratings are important, including ability to listen, personal connections, and customer service level of a physician’s office
  • Physicians aren’t yet accustomed to acting as consumers, so it will take anywhere from a few years to a full generation before behaviors change substantially

If you want to depress yourself about the potential for consumers to digest even excellent information, check out a post I wrote a couple of years ago (A pretty strong case against consumer directed care) describing the case of fertility clinics. Excellent information is published, but consumers don’t use it well. (In that post I also inadvertently set off a running battle in the comments and on other blogs on the topic of fertility and insurance coverage.)

February 12, 2008

5 thoughts on “Is transparency valuable?”

  1. Perhaps related to the unreliability and small sample size comment, one of physicians’ biggest complaints is that the claims data used to publish these quality scores are from a subset of payers – not Medicare or Medicaid or uninsured.

  2. Price data are irrelevant because patients don’t pay on this basis. Quality parameters were designed by academics and are similarly irrelevant. Patients assume licensing and accrediting bodies will assure quality in the technical aspects of care. Patients care about service.

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