Joe Paduda hosted the most recent edition of the Health Wonk Review – be sure to check it out, as he’s done an excellent job – as he always does. One of my favorite articles this week was highlighted by Joe Colucci of The New Health Dialog. Joe writes about this article by Shannon Brownlee, discussing transparency in medicine and patients’ ability to be “consumers” when it comes to healthcare. Shannon talks about her experience with shopping for replacement eye lenses to correct her cataracts. My mother had this same surgery done last year (with great results, by the way – after nearly 60 years of wearing glasses, she doesn’t have to wear them anymore. And of course, her cataracts are also gone), so I was especially interested in reading Shannon’s article.
We’re written about our own experiences with shopping around for healthcare, and how easy it is to end up with a higher medical bill than you’re expecting, even if you think you’ve accounted for everything and asked all the right questions. Shannon’s article takes things a bit further by talking about the decision-making factors that tend to be lacking even if price transparency exists (it did in her case, but often doesn’t). She was able to call around to several ophthalmologists and get specific prices for cataract surgery as well as the pricing for the three lens types available. But what she wasn’t able to determine had more to do with long-term safety and efficacy – did one lens outperform the other in the long-run? Were there complications associated more with one than another? Basically, what factors – other than money – needed to be considered? Shannon points out that the only real information she had about the various lenses came from the marketing brochures created by the lens manufacturers – and of course those are going to highlight the upsides.
Since most of us don’t have medical training, we might not even know the important questions to ask when we’re shopping around for healthcare. And even if we do, we also have to be able to discern whether the person we’re asking has any conflicts of interest (another excellent article in this week’s HWR from Dr. Roy Poses). Asking patients to have “skin in the game” sounds like a good idea until you really dig into what it means to be a healthcare consumer. Given the difficulty of comparing something as basic as prices for medical procedures – much less things like long-term safety and efficacy – it’s unlikely that patients can really be informed healthcare consumers unless things become a lot more transparent. More “skin in the game” probably just means patients pay more out of pocket for their healthcare (via higher health insurance deductibles and copays), or else put off healthcare until they can better afford it. Some might be shopping around, but it’s unlikely that many people are really able to be well-informed “comparison shoppers” yet – the information they would need just isn’t available.
Be sure to also check out Grand Rounds – hosted this week at Life With Huntington’s Disease.