I empathize with people who don’t take an active role in their health care decisions. There are real barriers to any of us really getting engaged: limited information about price and quality, a perpetuated culture of “doctor knows best,” and a daunting and confusing set of rules about coverage. Who wants to think about it?
There are only so many minutes in the day or neurons in the brain. So, we allocate our limited time, energy, and attention to the things that matter—right now.
Some things—even important things—simply don’t make the priority list. For instance, although I vote in national elections, I confess to not taking time to read up on every single proposition or referendum on my local ballot. While I care about the environment and wildlife preservation, I don’t know as much as I should about which products I should avoid to best protect Mother Earth. And, despite my desire to get a good price on groceries, I often just go to the closest store and get what I need without clipping coupons or checking sales.
I think my grandfather would have called my behavior lazy. But economists have a different term. Rational ignorance: a deliberate choice not to acquire (not to pay attention to) a certain kind of information because of its cost in terms of time and effort that yields little or no (perceived) benefit.
I’m not lazy, Grampa, just rationally ignorant.
In this light, one can’t be blamed for staring up at the Goliath that is health care and deciding that no single consumer can make a difference anyway. If insurance is going to pay for the colonoscopy at the closest hospital, why spend time and energy checking to see whether it costs less somewhere else? If my long-time, trusted doctor says I need surgery on my knee and orders an MRI, why endure the hassle of getting multiple opinions? If the recommended hospital has a nationally recognized, academic name, shouldn’t its reputation be enough? After all, no single decision made by a single person is likely to change the course of an entire system.
There are many, many reasons—protecting yourself from unnecessary risk and harm, achieving better outcomes, reducing out-of-pocket costs—for you to be actively involved in your health care choices. However, at any one moment, it may be difficult to detect that a question or choice makes any impact at all. Like any other small action—using one fewer plastic bag, taking a one-minute shorter shower, eating one more serving of vegetables, walking 10 minutes a day—we wonder, “Does it really matter?”
Like any social movement or groundswell idea, one action alone may not matter. But collective action—single decisions by many like-minded people—can make a huge difference!
Think of it this way: one person asking about quality and price may not prompt a hospital to give a straight answer. It’s not worth staff time and effort to respond to an occasional inquiry. But when every patient and employer, along with local and national media, ask the same question, it becomes more imperative to respond.
Perhaps the most powerful influence we can have as consumers is simply acknowledging that we HAVE choices and wondering, out loud, what those might be. The first step is simply presuming that we have a right to know more about the care we receive. Whether or not you plan to do in-depth research about your treatment options, consider asking your doctor three simple questions:
- What are the other options to address my condition?
- How does your quality and safety record compare to those of other providers? Can you document that?
- How does your price of care compare to those of other providers? Can you document that?
Your investment will be minimal. It requires little effort to ask the questions, and only a few minutes of your time to listen to the answers. But, imagine if providers had to answer these questions during EVERY visit. It wouldn’t take long before those who can’t answer get tired of evading or giving half-responses. Plus, you might learn something.
So, even if you plan to remain rationally ignorant, consider investing just enough energy to play the role of a consumer who has choices. You don’t have to become an activist, or an uber-purchaser. You can simply join a collective voice of customers, which we are, by asking some basic questions about the services we receive. Rather than taking on consumerism like David facing a scary giant, think of it more as if you were interviewing someone to work for you, which you are, and need to decide among applicants. Like any other contractor, you’d like some references and competitive bids.
Wendy Lynch is the director, Altarum Institute’s Center for Consumer Choice in Health Care. She blogs at the Prepared Patient Blog.