This interview is the ninth and final of a series of brief chats between CFAH president and founder, Jessie Gruman, and experts our CFAH William Ziff Fellows'who have devoted their careers to understanding and encouraging people's engagement in their health and health care.
Trudy Lieberman is concerned that despite all the rhetoric, choosing the best hospital, the best doctor, the best health plan, is simply not possible. Some of the so-called best might be good for some people but not others, and the information available to inform/guide choices is just too ambiguous.
Gruman: What has changed in the past year that has influenced people's engagement in their health and health care?
Lieberman: Costs have risen a lot, and employers and insurers have made consumers pay higher deductibles, co-pays and coinsurance.' The theory is, if people have to pay more of the costs themselves, they will become wiser consumers.' Have they become smarter about selecting the most appropriate, lowest cost services?' ' Too many times, the choice people make is to postpone going to the doctor even when they may need to go.' Of course, that means they may forgo needed care.' Research is beginning to show that is happening.
It's also good to remember that we don't have a real market in health care, even though health care sellers keep trying to tell us that we do.' ' One hospital administrator put it candidly; he said hospitals have to compete to bring more people to the hospital, and not necessarily to do a better job of treating them.' That's what happens in a for-profit system, which he says is the 'screwiest system ever designed.''
High deductibles, high copayments and high coinsurance demanded by health care providers at point-of-service act as barriers to care.' This is not the case in other countries where care is generally free at the point of service.' Of course, citizens of those countries pay for their care through a system of taxes, and all are entitled to care.' Those social insurance systems work much like our Medicare program.' So, when people have to think about covering the high costs just to get in the door, it's hard to see how they can engage with their providers when it comes to issues of treatment options and other quality-of-care concerns.
Gruman: What are some important challenges people now face in engaging in their health and care?
Lieberman: Sifting through all the marketing hype being thrown at us by the media is a tough slog.' We cannot even eat dinner and have the tv on without being pushed to ask our doctors about pharmaceuticals we may not need and diseases we don't have.' All this is geared to snare the consumer into becoming a patient who needs a drug to cure whatever ailment is being promoted. As we approach insurance open enrollment season, consumers are bombarded by ads from health plans and hospitals.' How do we know if an insurer or hospital is legitimate or if there is really an arms-length relationship between the rater and those being rated?' How do we evaluate one scheme over another?' One hospital, for instance, may do a bang-up job on heart care but a terrible job on infection control.' And when you are choosing a plan, how do you know what ailments you'll need care for?
There's a lot of talk about transparency, but cost information is really not transparent.' The explanation of benefits people receive are anything but transparent for a lot of people.' And you really can't figure out what prices insurers have negotiated with health care providers.' They are different for each one and they are deep, dark secrets.' So we really have to step back and see what's realistic before tossing around such nice-sounding words and phrases as transparency.' What do they really mean and for whom?
More patient engagement inteviews with our Ziff fellows by Jessie Gruman