The Myth of Health Care Consumerism

Last weekend I heard several great presentations at a meeting
convened by Jeff Goldsmith, but one contained a point I hadn’t heard
nailed down before. Kaveh Safavi MD JD, from Thomson Healthcare’s
Center for Healthcare Improvement, detailed the results of several
large sample surveys on consumers’ attitudes toward web-based health
care information.

One of Dr. Safavi’s opening slides came from Solucient’s HealthView
Plus 2006 data, and was focused on “Quality-Driven Consumers,” people
who are “likely to research ratings information on hospitals or
doctors,” and likely to change providers if the one they originally
preferred received a low rating. Strikingly contrary to the
conventional wisdom, this group makes up only 19%, or one-fifth, of
American adults.

The other categories are equally interesting. About one in eleven of us (9%) are “likely to
research” but “unlikely to change.” This group goes through the motions of
investigation but won’t switch when they find information counter to
their original preference.

One-third of us (34%) lackadaisically go with the flow. They are “unlikely to research” and “unlikely to change.”

And (this is my favorite) nearly two in five of us (38%) are “unlikely to
research” but “likely to change,” traits one audience member suggested be renamed to “Ignorance On Fire.”)

Assuming the trends described here hold up, these data have critical
weight for the many health care organizations that are focused on
consumer empowerment. If only 19% of America’s 200 million adults
engage to discover health care information that can be meaningful to
their own circumstances, then that changes things considerably. 38
million or so people is still a big number, but it is a lot less than
200 million.

And that raises some questions. Will consumers use Personal Health
Records? When they discover they have a particular condition, will most
people dive into the available resources to become knowledgeable about
it? Will the numbers described by the survey change as technology
evolves and we evolve along with it? Is our broad resistance to
pursuing information that is in our own interests a passing cultural
phenomenon, or is it a steadfast part of the human condition?

The data go on to show that Quality-Driven Consumers are
predominantly higher income, boomers, and Gen X adults. My guess is
that education, a comfortable technology proficiency, and reasonably
good personal management skills are common threads here.

But the subtext of this information is undoubtedly that the most
important changes coming in health care will occur not only in the ways
that consumers get and act on information, but in the ways that
organizations - health care and non-health care businesses - do. Even
though health care information can have serious utility for
individuals, many of us simply don’t appear to be built to chase and
use it. Businesses are different though. Most are based on a discipline
of following through, and they succeed or fail on their ability to use
information effectively.

All of this re-enforces my belief that, while we’re in a
fascinating, rich early stage of Health 2.0, where many of the sites
are focused on consumer empowerment, the bigger play will be for sites
that, in an increasingly competitive and value-sensitive marketplace,
create value by helping health care purchasers and vendors of all types
make better, data-driven decisions.

This will become meaningful as it becomes more and more possible for
businesses to buy coverage based on which health plan has the best
performance record. Or as health plans really do try to assemble the
most efficient (rather than simply the largest) provider network. Or as
hospitals focus on identifying the best performing hip for their
hip-replacement patients. Or as doctors determine to follow a
condition-specific protocol that has a track record of consistently
producing the best outcomes at the lowest costs.

Consumer-oriented applications are easier and cheaper to develop and
bring to fruition than business-oriented, data-intensive ones. But the
imperative to succeed in an intensifying marketplace could ultimately
swing the pendulum toward Health 2.0 applications aimed at business. If
and when it does, then the resulting transparency, decision-support and
impact on market dynamics could drive many of tremendous changes in
health care that we’ve all been looking for.