With all of our (including my) talk about Health 2.0 and consumerism in American health care, the fact remains that most Americans rely on family and friends to find a primary care physician (PCP). That would be known as “word-of-mouth.” 27% of people rely solely on their friends’ and relatives’ opinions about PCPs. On the other hand, 2 in 5 people use multiple sources to find a PCP.

When it comes to selecting a specialist, it’s a different picture. 2 in 3 Americans take their PCPs’ referral advice. Sicker people tend to go with their PCP’s recommendations. But 1 in 5 also use their family and friends’ opinions to choose a specialist.


The Center for Studying Health System Change (CSHSC) analyzed data from their Health Tracking Household Survey to test a working hypothesis that Americans as health care consumers would choose to use quality and price information when assessing their options of physicians and facilities for procedures.

The Internet as a source for selecting a PCP places a distant fourth after health plans, which appear to be trusted sources for selecting a PCP. People who rely on health plans and Internet more for choosing a PCP tend to be younger and better educated than the average for the sample polled.


CSHSC found that about 25 million adults (= 1 in 10 American adults) looked for a new PCP in the previous 12 months. While 17 million reported finding a PCP, the rest of the 8 million people did not.


As the table on the left illustrates, Americans aren’t exactly engaged health care shoppers. Only 5% are looking at price information in PCP settings, and only 1% for specialists and procedures. When it comes to assessing quality, 23% of people are looking at quality relatively to PCPs; and only 10% are using quality information on specialists.

The Health Tracking Household Survey data was collected between April 2007 and January 2008.

Health Populi’s Hot Points: “The consumer-directed health care vision of consumers actively shopping is far removed from the reality of how most consumers currently choose health care providers,” CSHSC believes. For primary care choice, the Center’s poll found that there are many factors citizens consider when picking a PCP including whether the provider is in-network (a proxy for cost-sharing), perceived quality and reputation, and convenience. For specialists, it’s also these three metrics, although to a lesser extent for each. For procedure shopping consumers equally weigh in-network vs. out-of-network, perceived quality, doctor’s recommendation, and convenience.

Based on the fact that word-of-mouth continues to pervade Americans’ health shopping habits, a physician will benefit who has outstanding exam-room manner and personal accessibility with patients. Perhaps this is the sort of grading that can be encompassed in a Zagat-type guide to docs, but it’s not nearly what the Agency for Healthcare Research and Quality would condone as the be-all, end-all source on physician quality.

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