Importance of factors selecting a doctor JAMA Feb 14 Hanauer

As more U.S. health citizens enroll in high-deductible health plans – now representing about 30% of health-insured people in America – health plan members are being called on to play the role of consumer. Among the most important choices the health consumer makes is for a physician.

Ratings sites and health care report cards ranking doctors by various characteristics have been in the market for over a decade. However, little has been known on the public’s knowledge about the availability of these information sources, nor of peoples’ use of physician rating sites.

This question is addressed in Public Awareness, Perception, and Use of Online Physician Rating Sites, in JAMA, February 19 2014 issue. Dr. David Hanauer and colleagues from The University of Michigan conducted a national sample of 3,563 online U.S. adults in September 2012 to gauge their perspectives on physician rating services. The response rate was 60% (representing 2,137 people), roughly split between men and women.

The most important factor in picking a physician wasn’t found to be “bedside” exam room manner or years of experience, but whether the doctor accepted the patient’s health insurance. 95%, virtually the entire survey sample, said this is an important factor in picking a physician. The second most important factor was location, followed by the physician’s experience.

59% of people said physician rating sites would be important when picking a doctor (somewhat 40%, very 19%). Word-of-mouth from family and friends was ranked higher than the physician rating sites, as the chart shows.

With respect to awareness, consumers are much more aware of ratings sites for cars, movies or books, electronics and appliances than they know about ratings for physicians, hospitals and dentists.

Among the 65% of people who are aware of websites that rate physicians, 17% of consumers said they had gone online at least once in the past year to seek a physician rating. Among these, 93% of consumers using the ratings found them either very or somewhat useful. Only 5% of people have ever given ratings for doctors, compared with 14% of people who have offered online reviews or movies or books, and 12% of people who have done online restaurant reviews.

Health Populi’s Hot Points: Health insurance – broadly speaking, health financial issues — trump peoples’ choice of doctors above all other factors when it comes to people considering “very important” factors in picking a physician. When looking at other factors’ “somewhat importance,” other factors come into play.

But ratings rank dead last compared to health insurance coverage, convenient office location, physician’s years of experience, part of a trusted group practice, word of mouth from family and friends, and referral from another physician, with the raw data shown in the chart.

There is lower level of awareness of provider rating sites compared with ratings for consumer goods. Consumers have had decades’ worth of experience looking at and comparing the Consumer Reports’ “moon” dots ranging from excellent to poor, for washing machines and four-door sedans, kitchen blenders and fast-food restaurants.

Now comes Consumers Union’s stake in the ground in rating doctors and health insurance plans, along with J.D. Power and Associates’ many years of assessing health insurers. We need a Zagat and TripAdvisor for health care — not just an OpenTable.

With health consumers (reluctantly, mostly) taking up the mantle of consumer behavior, provider rankings along with clear pricing transparency and quality measures are under-supplied. Plan sponsors — employers, unions, and government agencies alike — are choosing to amp up consumer-driven health care through expanding the use of high-deductible health plans coupled with HSAs and wellness programs. But the value-chain link breaks at the point-of-decision making for consumers who too often lack the tools to help them on that consumer-directed health journey.

There’s a growing number of companies edging toward the model. I laud UnitedHealthCare’s launch of the MyEasyBook portal, discussed here on Health Populi. I admire the work of Clear Health Costs, PokitDoK, ZocDoc, and other online health care marketplaces that are closing the chasm between wishing to find a doctor and making an appointment to see one.

But the pace of change here has been slow, with the growth of the supply side of HDHPs growing far faster than the tools and help people need to effectively use these plans for their health and wellbeing.