Consumer-Directed Care's Achilles Heel

Despite all the hype about consumer-directed care and the ability of financially motivated patients to make good health-care buying decisions, it’s long been known that most consumers don’t pay attention to the increasing amount of web-based information about doctors and hospitals. A new study by the Center for Studying Health System Change (CSHSC) shows that none of the “transparency” efforts by health plans, the government, and assorted vendors have moved the needle in the past several years. Most people still rely on word of mouth and health-plan directories when choosing a primary-care physician, and they tend to depend on their primary-care doctors to select a specialist or a hospital.

Using a nationally representative survey, the CSHSC researchers found that use of online provider information was low. Three percent of consumers who needed surgical procedures, 7 percent of those who were choosing new specialists, and 11 percent of those seeking new primary-care doctors went online to find data that could help them make a choice. A smaller percentage of respondents visited websites to locate price information than to look up quality data, perhaps because less of it is available and because they have no compelling reason to compare prices.

Of course, there are lots of other reasons why people might not bother going to provider rating websites. When choosing a physician, many consumers assume that clinical quality differences among doctors are fairly minor; they may be more concerned about a doctor’s location and whether she’s in their health plan network. If they’re facing a serious medical issue that requires seeing a specialist or being admitted to a hospital, they tend to rely on their primary-care doctor’s expertise.

But even if they were interested in going online—and they weren’t among the 90 million Americans with low health literacy—they’d find very little on the web to illuminate them. In an amusing Slate article, Dr. Kent Sepkowitz relates his arduous journey through a batch of sites that provide information on and patient ratings of doctors. “Here’s what I found: zilch,” he writes. “The online doctor rating system has a shocking lack of useful information.” It’s also easily manipulated, he discovered when he posed as a patient and posted enthusiastic comments about his own medical skills and affability.

There are sites that offer real quality data, including CMS’ HospitalCompare and sites that compare the performance of large physician groups in California, Minnesota, and Wisconsin. But overall, there’s no indication that consumers are about to rush onto the web to choose healthcare providers. And that’s bad news for those who think that consumer-directed plans are the answer.