Wild West is ghost town, for now…

Throughout 2008, we’ve been talking about the ever-increasing resources available to patients to inform better healthcare decisions. (Check out our paper “Pointing the Way” issued in February.) We like to use the “Wild West” metaphor to describe all the online ratings sites, patient feedback forums and hospital comparison options. Just a couple of years ago patients had a hard time finding any information regarding quality, pricing or other value points for healthcare decisions. Now, there are so many options, it feels like the wide open, chaotic, anything-goes Wild West. But despite the proliferation of online resources (or, perhaps, in part, because of it), most people still rely on word-of-mouth and physician referrals to chose care. That’s according to a report issued in December by the Center for Studying Health System Change, funded by the California HealthCare Foundation.

According to the study, when people were selecting new primary care physicians, 50% relied on word-of-mouth recommendations from friends and relatives, while 38% also used physician recommendations and 35% health plan information (40% of respondents to the survey used more than one source of information when choosing). Moreover, most consumers relied exclusively on physician referrals when it came to choosing specialists and facilities for medical procedures.

These findings jibe with the traditional views on patient decision-making, supported by research from folks like Press Ganey over the years. Word-of-mouth has always been at the top as far as patient information sources, with physician guidance right behind. Does this mean the impact of consumer-driven healthcare, and the related drive to inform patients through third-party resources, has been overblown? Well, not necessarily. Certainly, changing patient behavior, thought patterns and research methods won’t happen over night. And word-of-mouth and physician referral will most likely always be among the top resources for patients. But the study itself needs to be reviewed in the proper context. Despite the December 2008 release date, the survey itself was conducted between April 2007 and January 2008, 12-18 months ago. A lot has changed since then. More people are in consumer-driven plans with high deductibles and copays, meaning more people will be “shopping” for care. More resources – including HCAHPS and Consumer Reports – have joined the fray, providing more prominent resources for consumers. Perhaps most notably, the economy has gone in the tank, which inevitably is forcing those with more financial skin in the healthcare game to be more prudent with their dollars. That, in turn, will likely lead to more price shopping, and less trust of a physician’s recommendation (“Do I really need that MRI? How much does it cost? Maybe I should shop around.”)

Our guess? While the traditional influences on consumer healthcare decisions will still hold sway in 2009, other forms of influence, from employer-sponsored guidance to third-party web sites, will continue to grow in strength.