“Choice” in Health Care: What Do People Really Want?
By Jeanne M. Lambrew, Ph.D.
The Commonwealth Fund
September 2005
Abstract:
Proposals to expand the individual health insurance market and promote health savings accounts are intended to provide consumers with more “choice.” The types of choices people prefer, however, are not well understood. This analysis of survey data finds that having a choice of health care providers matters more to people than having a choice of health plans. Dissatisfaction among adults with no choice of providers was more than twice as high as among those with no choice of plan. Moreover, a large majority of Americans who have had experience with employer-based health insurance believe that employers do a good job of selecting quality plans.
Two of three preferred an employer-selected set of plans over an employer-funded account that they would use to find coverage on their own.
Thus, policymakers should be cautious about embracing the individual market and health savings accounts as a way to improve satisfaction in the system.
http://www.cmwf.org/usr_doc/lambrew_853_choice_ib.pdf
Comment: The debate over “choice” in health care is more than a rhetorical game; it drives policy.
This survey adds to the research that confirms that patients clearly do want to have choice of their providers of care, including physicians and hospitals, and that provider choice is much more important than having choice of insurers. Yet advocates of market approaches to health care funding tout choice of health plans as if that were the only choice that consumers want, and most plans do restrict choice of providers to varying degrees.
An important finding of this study is that individuals do have confidence in plans that are selected by employers. As long the plan covers the patients’ own providers, they could care less which insurer is providing the administrative services. In contrast, if the insurer takes away patients’ choices of providers, then they are displeased with that plan. (Kaiser Permanente is not an exception because patients have selected that system as their provider.)
Recently, we’ve seen an increase in political support for providing incentives to choose products in the individual insurance market. Insurers recognize that beneficiaries do want to have greater choice of their providers. Thus we are seeing larger lists of approved providers, along with coverage for out-of-network providers, albeit with financial penalties. But this relaxation of the exclusions from provider lists may represent a Hobson’s choice.
The tradeoff for having greater choice of providers is to relinquish the financial security that insurers traditionally provided. Having a choice of a physician who you cannot afford provides less choice than the first horse at the stable door. After all, Hobson did provide a horse, but the insurers are no longer providing financial security in the event of loss.