Consumer Choice in the Health Insurance and Provider Markets: A Look at the Evidence Thus Far,

URL:

Abstract:

Despite the momentum in this area, it is not easy for consumers to make evidence-based decisions about their health plans and providers. There are several reasons for this. First, there is a relative dearth of information on quality. Second, choosing between health plans is not as simple as it once was because there is no one-size-fits-all or “right” answer. Third, out-of-pocket costs are increasingly a factor. Consumers are also at a distinct information disadvantage when it comes to choosing providers, since they lack clinical knowledge and may not understand the full spectrum of factors that should be weighed in the decision (e.g., years in practice or board certification). However, consumers do not act alone in making these decisions, and the choices available to them—for health plans and providers—are sometimes limited. For example, employers affect the choice of health plan and associated costs, and access to providers may be limited if demand for their services exceeds their capacity. Furthermore, consumer choices are likely made in consultation with outside advisors or agents.