The emergence of the new health care consumer - Part 1: Health Care Futures - Panel Discussion

Physician Executive,  May-June, 1998  by Robert P. Carlson

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Rippen: There's a recent survey from William Mercer & Company, I think, about employer concerns in choosing an HMO. The first one was access and coverage and I think the fifth was member satisfaction because obviously cost, quality of care, financial strength, and stability beat out member satisfaction.

Weatherup: I'd just like to respond on behalf of General Motors that there are two reasons why we care a lot about the satisfaction of our employees with their health plan. One is we truly want them to have a good experience and to enjoy their benefit and get what they deserve. The other reason is that our collective bargaining partners in organized labor pay a lot of attention to the satisfaction of their members with their health plans, and when they're unhappy, they point it out to us.

Holt: But even a detailed analysis of the quality of different services being provided by heart surgeons in New York and all types of hospitals in Pennsylvania hasn't changed the referral patterns or network selection that much.

Reinhardt: There's also an article in The New England Journal of Medicine about the Pennsylvania data on the cost and outcome of heart surgery. In Pennsylvania, the cardiologists do not even respond to either cost or quality in recommending surgeons to patients. They used MediQual's Medi-Group software which predicts mortality on the basis of health status of the patient coming into the hospital. So it's about as clean as the software now allows you to make it. And the variation in excess mortality rates and costs across hospitals and surgeons are stunning when you see them plotted. Those hospitals are all over the map. There are a lot of hospitals with high cost and high excess mortality and yet they are chosen.

The Physician Executive: What do you mean by excess mortality?

Reinhardt: Excess mortality here means mortality over and above that predicted on the basis of the patient's age, gender, and health status upon admission to the hospital.

The Physician Executive: Are the concepts of health care consumer and customer in flux these days?

Reinhardt: I would argue yes. I believe the health plans, and to some extent the providers behind the plans, basically have disregarded the role of the patients, who are the ultimate buyers of insurance coverage. That is why patients all over the country are running to the government. That's why you have the Clinton Health Quality Commission and the legislation that will come down the pike. I think that is part of the consumer movement. Oddly, they went to the government, rather than complaining to the health plan to ask, "Why don't you treat us with more respect?" Evidently, the health plans were too arrogant in their dealings with consumers and [the plans] are only now waking up to this failure,

Rippen: Part of it has to do with the idea that "this is all you're going to get." You know, if you have this condition, whether you want to stay longer or not, you have to leave. And the health care provider is saying, "Hey, I can't do anything about it. My hands are tied."