Health Affairs: Policy makers not in tune with healthcare consumers
Many consumers’ beliefs and knowledge are at odds with what policy makers prescribe as evidence-based healthcare, according to a Health Affairs study posted online.
Kristen L. Carman, co-director of health policy and research at the American Institutes for Research in Washington D.C., and colleagues found that few consumers understood terms such as “medical evidence” or “quality guidelines.” Most believed that more care meant higher quality, better care, the researchers found.
Carman and colleagues held focus groups, interviews and an online survey with healthcare consumers age 18-64 who held health insurance through a current employer and taken part in making decisions about health insurance coverage for themselves, their spouse or someone else.
Study participants did not generally understand that variations in the quality of care exist. According to the study, only 34 percent of participants ever recalled having a physician discuss what scientific research had shown about the best way to manage their care.
“Many participants assumed that their healthcare providers always based decisions on medical evidence, which to them consists just of ‘things like my test results and medical history’,” the report stated.
Although focus-group participants could envision a healthcare provider making an occasional mistake, Carman and colleagues reported that they found it hard to believe that providers could deliver truly substandard care. When participants were told that providing beta-blockers for heart attack patients represents the accepted standard of care, but 25 percent of patients do not receive them, “participants immediately offered justifications for the lack of treatment: the patient was ‘allergic,’ the hospital was ‘too poor’ to provide the drugs or the doctor knew the patient needed a different mediation.”
Participants also believed that any new treatment is improved treatment. “This attitude may help explain the survey finding that only 47 percent of respondents agreed that it is responsible to pay less out of pocket for the most effective treatment and drugs,” the article reported.
A significant portion of participants also believed that costly care is effective care. Thirty-three percent agreed or strongly agreed with the statement “medical treatments that work the best usually cost more than treatments that don’t work as well.” Twenty-seven percent disagreed or strongly disagreed this statement while 40 percent were unsure about the comment.
Moreover, the study showed health consumers are often reluctant to question or challenge their doctors, on whom they rely heavily for information, interpretation and guidance for treatment options.
The study acknowledged its limitation that the findings over-represent people who were employed, insured and identified themselves as responsible for healthcare decision-making. “As a result, we would expect that our study population is consistently biased toward a ‘best case’ scenario: that individuals understand and value evidence-based healthcare,” the authors stated.
The researchers noted that moving forward, it will be difficult to motivate consumers to accept evidence-based medicine given that healthcare decisions are becoming increasingly complex, and the general public has relatively low levels of health and scientific literacy.
“The gaps in knowledge and misconceptions point to serious challenges in engaging consumers in evidence-based decision making,” the researchers concluded. “Effective communication with and support of consumers is essential to improving the quality of healthcare and containing healthcare costs. Clearly, consumers will revolt if evidence-based efforts are perceived as rationing or as a way to deny them needed treatment.”
Funding for the study was provided by the California HealthCare Foundation and the National Business Group on Health.
Kristen L. Carman, co-director of health policy and research at the American Institutes for Research in Washington D.C., and colleagues found that few consumers understood terms such as “medical evidence” or “quality guidelines.” Most believed that more care meant higher quality, better care, the researchers found.
Carman and colleagues held focus groups, interviews and an online survey with healthcare consumers age 18-64 who held health insurance through a current employer and taken part in making decisions about health insurance coverage for themselves, their spouse or someone else.
Study participants did not generally understand that variations in the quality of care exist. According to the study, only 34 percent of participants ever recalled having a physician discuss what scientific research had shown about the best way to manage their care.
“Many participants assumed that their healthcare providers always based decisions on medical evidence, which to them consists just of ‘things like my test results and medical history’,” the report stated.
Although focus-group participants could envision a healthcare provider making an occasional mistake, Carman and colleagues reported that they found it hard to believe that providers could deliver truly substandard care. When participants were told that providing beta-blockers for heart attack patients represents the accepted standard of care, but 25 percent of patients do not receive them, “participants immediately offered justifications for the lack of treatment: the patient was ‘allergic,’ the hospital was ‘too poor’ to provide the drugs or the doctor knew the patient needed a different mediation.”
Participants also believed that any new treatment is improved treatment. “This attitude may help explain the survey finding that only 47 percent of respondents agreed that it is responsible to pay less out of pocket for the most effective treatment and drugs,” the article reported.
A significant portion of participants also believed that costly care is effective care. Thirty-three percent agreed or strongly agreed with the statement “medical treatments that work the best usually cost more than treatments that don’t work as well.” Twenty-seven percent disagreed or strongly disagreed this statement while 40 percent were unsure about the comment.
Moreover, the study showed health consumers are often reluctant to question or challenge their doctors, on whom they rely heavily for information, interpretation and guidance for treatment options.
The study acknowledged its limitation that the findings over-represent people who were employed, insured and identified themselves as responsible for healthcare decision-making. “As a result, we would expect that our study population is consistently biased toward a ‘best case’ scenario: that individuals understand and value evidence-based healthcare,” the authors stated.
The researchers noted that moving forward, it will be difficult to motivate consumers to accept evidence-based medicine given that healthcare decisions are becoming increasingly complex, and the general public has relatively low levels of health and scientific literacy.
“The gaps in knowledge and misconceptions point to serious challenges in engaging consumers in evidence-based decision making,” the researchers concluded. “Effective communication with and support of consumers is essential to improving the quality of healthcare and containing healthcare costs. Clearly, consumers will revolt if evidence-based efforts are perceived as rationing or as a way to deny them needed treatment.”
Funding for the study was provided by the California HealthCare Foundation and the National Business Group on Health.