Most patients don’t comparison shop

The flood gates have opened.

Hospitals and physicians are releasing a deluge of data on their performance, bowing to mounting pressure from consumer groups, employers and lawmakers.

But with the release of such information, the question remains: Will it compel patients to act more like thrift-minded consumers whose clout will restrain price inflation and boost service quality?

Employers and other big purchasers of health care expect much from an injection of consumerism into the market for health services. But even the most ardent advocates acknowledge that consumer-directed health care still has far to go before delivering its hoped-for results.

“I think it’s going to be a number of years,” said Will McKinney, a vice president with Regence BlueCross BlueShield health plans.

The data remain an obstacle. Performance ratings are crude, difficult even for experts to interpret, and potentially misleading.

Several private companies are attempting to fill the void with proprietary rating systems. But they face reliability problems of their own, as highlighted in a recent study by the University of California at Los Angeles. Two hospital surgery programs given the highest ranking by one or two commercial Web sites received the lowest rating from another Web site. Two other surgery programs received contradictory ratings of average or excellent, depending on which company judged them.

Patients, for their part, have shown little interest in shopping for health care in the same way consumers hunt for deals on appliances or automobiles. Where employers or states established some of the first detailed report cards on hospitals and doctors, the impact has been minimal.

During the 1990s, the Cleveland-based Health Quality Choice program disclosed several hospitals with consistently higher than expected death rates. But none of the hospitals lost patient business, according to a 2003 study by Case Western Reserve University.

More recent studies in New York and California likewise found public reporting barely influenced the flow of patients to hospitals with high death rates. And hospitals with low death rates didn’t gain any business.

National surveys suggest that most people aren’t aware of the quality comparisons. Among those who are familiar with report cards and ratings, confusion and distrust are rampant. Surveys have found that most people prefer the advice of trusted friends, family and personal physicians over published information or government sources.

To boost consumerism, many companies are making employees shoulder an increasing share of medical costs, for instance, by switching to high-deductible health plans that won’t cover bills until they reach $1,000 or an even higher deductible level. People in high-deductible plans, the thinking goes, will be more likely to compare prices for health care.

But people with high-deductible coverage showed no more cost-consciousness than others in a recent survey by Regence BlueCross BlueShield of thousands of members in Washington, Oregon, Idaho and Utah. Similar findings emerged in a 2006 national survey by the Employee Benefits Research Institute and the Commonwealth Fund.

Regence’s Robert Harris, who co-authored the survey, said he found signs of increasing interest in comparison shopping. Overall, seven out of 10 people said they would seek information before undergoing a medical test or procedure. Among those wanting information, more than three-fourths wanted data on the quality of care. But only a third said they were very likely to compare prices.

“There is a portion of the population who are shoppers,” Harris said. “Given the tools, they will shop for health care as well.”

McKinney said Regence has put a priority on finding ways to present price and quality information in more useful ways for members.

“As time goes on, people will hold providers to a higher standard,” McKinney said.

Others are skeptical. Lynne-Marie Crider, public policy specialist with the Service Employees International Union in Portland, said that even the most well-informed individuals will always lack market clout to pressure hospitals or physicians to cut costs or improve quality.