Shopping for health care is not like shopping for furniture, cars, clothes or anything else. Traditionally, health care consumers have been relegated to the passive role of patient in the consumption process, with health care providers prescribing treatment and third-party payers dictating the purchase process. In fact, it is often said that people don’t shop for health care, they shop for health insurance and get health care. The shift toward consumerism in health care has been well-publicized in recent years, but the implications are just beginning to be understood. Consumerism is built on the premise that informed consumers have a greater capacity to understand the impact of their purchasing decisions and make choices that best meet their needs and expectations. When applied to health care, the idea is that when people are given more responsibility, choice and information about where and how they are going to receive health care and from whom, they will become more active participants in the management of their own care and actively seek options that align with their preferences, values, needs and expectations. Unfortunately, a number of the factors make health care a unique industry that continues to impede the ability of consumers to make rational decisions.
Consumers are often unable to evaluate health care services
The high credence of health care services and consumers’ lack of knowledge about how the health care system operates make accessing, consuming, and evaluating health care services a unique challenge. While the high credence of health care may hamper the ability of consumers to evaluate services provided, the information asymmetry created by health care providers operating in silos and treating health information as proprietary data, as well as insurance companies protecting their own interest results in health care consumers lacking the ability to make informed decisions.
Consumers have little choice but to participate in the market
Unlike other goods and services, consumers have little choice but to participate in the market—there is little option to “opt out” of health care. One may choose not to buy a car and opt to rely on public transportation, taxis, or ride-sharing services, walk, ride a bicycle, or find some other means of transportation. Numerous alternatives can be found for most all other product categories; but virtually everyone in modern society interacts with the health care industry at some point. In 2014, only 1.5% of all births in the U.S. occurred out-of-hospital, and the vast majority of these births still involved a health care professional. On the other end of life, some 60% of Americans die in acute care hospitals and another 20% in nursing homes. Of the remaining 20%, again, the majority utilize health care professionals through palliative and hospice care. Even if someone desired to “opt out” of health care, they would likely receive medical treatment following an emergency that left them unconscious.
The lack of freedom faced by consumers inherently changes the purchase decision-making process. If a consumer doesn’t find the price of a car agreeable, for example, they can just walk away. But someone having a heart attack can’t shop around or delay treatment. Also influencing the decision-making process is the strong role of emotions, situational urgency that may occur, and the nature of the consequences that may follow a decision.
