Duncan Cross and David Williams and Niko Karvounis have all written articles about the Kaiser study that indicates that most people (about 85% of us) aren’t using quality comparison websites when making health care provider choices. All three articles make good points, and it got me thinking about my own family’s choices with regards to health care providers.
We’ve used lots of different criteria for picking doctors; how we go about it depends on the situation. When Jay needed to have a lipoma removed last year, and we knew we’d have to pay for it ourselves since it was excluded as a pre-existing condition on our health insurance policy, he did a lot of shopping around before selecting a doctor. We wanted to use a dermatologist, since we assumed he would get a better outcome with a specialist (we’ve since talked to people who’ve had lipomas removed by primary care docs and had great outcomes and a lower bill. Live and learn). But price was our primary concern, and that was the criteria we used to pick a doctor. Not that it did us any good.
When Jay injured his knee last year, we knew that it would likely need surgery and that we were going to have to meet our health insurance deductible no matter what doctor we saw. It wasn’t a dire emergency, so we had time to compare doctors. When we found out that Dr. Steadman and the Steadman/Hawkins clinic are on our PPO network with Humana, our decision was easy. For his knees, Jay’s primary criteria for picking a provider was quality, and driving back and forth to Vail numerous times this year was worth it to us for the quality of care that he received.
When we were expecting our son last year, we chose a midwife based on a recommendation from a friend. We knew we wanted a homebirth, and we trusted our friend’s recommendation. Our midwife was fantastic. Her price was about average for this area for someone with her level of experience (she’s been a midwife since I was in middle school – this is one area where I’d rather pay a little more for someone with experience).
When our son was born, we asked our midwife if she could recommend a doctor for him. We trusted her, and knew that she worked with a lot of parents with values similar to ours. She recommended a family practice doctor who takes care of a lot of babies that our midwife has delivered over the years. She’s on our PPO network and has been a good fit with our family (all we’ve had so far is well checks, so going to the doctor has been pretty easy). She’s in Boulder, which is a bit of a drive for us, but our midwife’s recommendation mattered to us, so we’re willing to make the trip.
Recently I needed to see a podiatrist. It was a relatively minor issue that ended up needing two office visits of about 15 minutes each. We’ve already met the deductible on our HSA this year, and since I knew that my foot could be fixed by pretty much any podiatrist, my only criteria was to find the one closest to our house and on our health insurance network. I ended up finding a doctor in Broomfield about 3/4 of a mile from our home. He did a great job, although I’m sure any doctor would have done just as well. For me, all that mattered was convenience.
So my family – with a relatively limited medical history – has run the gamut of decision making protocol that people use to pick providers. Cost, quality, convenience, personal recommendation… we’ve done them all. I think that it depends on the situation. For a serious health problem, it probably pays to search for quality. But then again, a personal recommendation might get you a doctor who makes you feel more comfortable – and that’s hard to quantify. Healthcare is a complicated issue – one that involves reason, emotion, and logic all at once. Obviously we want the best outcome, but we also need convenience and affordability and a doctor with whom we ‘click’. Quality rankings are a piece of the puzzle for sure, but they’re not the only piece. I do think they will get more popular as time goes by and especially if health insurance carriers start actively encouraging patients to choose doctors from among the highest ranking providers on the comparison sites. But there are other factors that go into choosing a provider that can’t be quantified on a spreadsheet or a graph.