stuart elway
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Economic Disruption in Healthcare
Symposium - Part II
H. Stuart Elway, PhD
Will Consumers Shop
For Health Care?
Health Care Moving to
Consumer Choice Models
• Will health care consumers price shop?
• Do consumers exercise choice now?
• Do consumers want more choice?
• Is it even possible for consumers to
shop?
Health Care System
Through the Eyes of the
Consumer
Public Agenda Foundation
• Most unaware of how HCS really works
• Concerned about personal HC spending
– Only 30% confident they can afford
care they need
• Concerned about national spending trends
• Support cost-saving concepts,
but no consensus
Our Research
• Focus Groups
• Survey of WA residents
– 500 heads of household 18-64
– March 13-18
Respondent Profile
42% over age 50
16% under 35
68% Couple
41% Children at Home
60% Employed Full Time
14% Employed Part Time
53% College Degree
System Usage
82% have regular physician
37% did own research
20% visited Doctor 0-1 times last year
21% visited 12+ times last year
52% saw specialist in last year
Health Insurance Coverage
2215
11
48
5
Self-Pay
Partial Pay
Employer Pay
Other
No Insurance
60% Chose from
among plans offered
by employer
Reason for Choosing
Insurance Plan
53% Do not know
their Maximum
Out-of-Pocket Limit
Why is Health Care So
Expensive?
26
20
20
15
10
6
13
12
Medical providers
Consumers
Government
General cost
pressures
Insurance
companies
Attorneys/lobbyists
Other
None/DKNA
Potential Impact of Comparison
Shopping on The Health Care
System
Advantages / Disadvantages
of Shopping for Medical
Treatments
Advantages
48% Lower Cost
37% Choice
14% Better Quality
2% No Advantages
Disadvantages
33% Quality Concerns
27% Consumer Burden
6% Higher Costs
2% Less Choice
18% No Disadvantages
Consumers Able /
Want to Price Shop?
Why Shopping Would be
Personally Desirable /
Undesirable
Desirable
30% Choice/Control
30% Lower cost
18% Better value
14% Better quality
Undesirable
40% Not Needed
26% Consumer
burden
18% Lower quality
9% Higher cost
Potential Impact of Consumer
Shopping
on Health Care
71
66
62
11
6
13
Cost
Access
Quality
Pos Neg
Would You Price Shop
for Treatment
HESITATION:
30% Quality of Care
21% Happy w/ current Dr
13% Price Not Everything
13% Specific situation
9% Consumer burden
8% Use recommendations23
1175
54
Definitely Maybe Probably not Definitely not Depends
Likely to Price Shop for
Specified Procedures
59
54
51
46
41
17
19
13
27
26
Laser eyesurgery
Kneereplacement
Heart surgery
Back pain
Blood pressure
Very Likely Maybe Unlikely Very Unlikely
20
25
34
25
30
Past “Shopping” Behavior
60
36
18
30
14
49
35
24
0
10
20
30
40
50
60
70
Shopped for
Insurance
Chose
between
plans
Chose
Lowest price
plan
Chose Dr.
on own
Chose
Specialist on
own
Asked abt
Cost
Forgone due
to cost
Chosen
Treatment
on Cost
PROVIDERINSURANCE TREATMENT
Hypothetical: Choose Provider
69% aware that different providers charge
different fees for same treatment
PROVIDER A: $10,000
PROVIDER B: $7,500
Hypothetical: Choose Provider
PROVIDER A
56% Better Care
16% Not Sure
PROVIDER B
90% Cost savings
22% If Quality Equal
Hypothetical: Choose Provider
“DEPENDS”
71% Quality of Care
17% Cost not only concern
12% the Procedure
Additional $$ Factors
5
6
7
45
44
44
13
14
18
16
50
19
19
INITIAL
CO-PAY
REBATE
A $10,000 B $7500 Much More Maybe Depends/ Undec
Potential Impact of Rebates on
Health Care System
60
62
59
46
19
12
9
23
Overall
Cost
Access
Quality
Pos None Neg
Impact of price shopping
on overall cost of health
care
25
3120
22
Significant Maybe Not signif None
37
43
17
2
Long way Maybe some Little/None
Impact on personal
decisions
of lowering overall cost
So, Will Consumers Shop?
Foreign concept – Difficult to relate to the question
– Seen in familiar insurance context
Indicate willingness on surface– Have not thought it through
– Reluctant when given time to consider
Seen as shifting cost to consumers– Personal costs rising as it is
– Concern that result in avoidance of care
So, Will Consumers Shop?
Care Situation– Emergency
– Costs of Component treatments
– Reluctance to second guess Doctor
Information– Lack of expertise, confidence
– Learning curve (time burden)
– Lack of information (comparative data)
Significance of choice
So, Will Consumers Shop?
Quality is the trump card
Door is open to discussion
Economic Disruption in Healthcare
Symposium - Part II
H. Stuart Elway, PhD
Will Consumers Shop
For Health Care?
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