Pin the Tail on the Doctor

A dearth of information leaves health-care consumers in the dark.

Anecdotal evidence suggests that consumers become more comfortable using information over time. Visits to’s cost and quality information pages jumped from about 1,500 per month in 2005 to between 6,000 and 10,000 per month in 2006, says Jim Nastri, Cigna’s vice president of new-product development and cost and quality transparency.

Since about 2001, General Electric has been sending employees E-mails with quality measures for different health-care providers. Early surveys and focus groups revealed that initially employees didn’t believe that significant differences in quality existed, says CMO Galvin. They questioned the source of the information and the motives behind the E-mails. “At first they thought we just wanted to save money,” he says.

Over the next several years, employees came to realize that the information was legitimate. Eighty-five percent of respondents to current surveys say they believe different providers offer different levels of quality. “It’s a culture change,” Galvin says. “Not long ago, if you saw a nice hospital with big pillars, you thought it was OK.”

Of course, the real question underlying the move to greater transparency is whether it is likely to have an impact on health-care costs and quality. Transparency can have some effect on prices, says Nastri. For example, doctors’ costs vary depending on which hospital they admit to. In many markets, Cigna members have a choice of several hospitals they can use for elective procedures. Many doctors who admit to higher-cost hospitals are working with hospital administrators to understand and reduce cost drivers.

In addition, Cigna employees analyzed 38,000 members’ use of consumer-driven health plans. They found that costs for these members were 16 percent lower than costs for those enrolled in traditional plans, says Nastri.

This supports a 2004 study in the journal Health Affairs, which showed that patients who received more information and understood that they could participate in decisions regarding their care were less likely to choose elective surgery than was a control group.

When it came to back surgery, for instance, 26 percent of the patients who were more involved in the decision-making process chose surgery, compared with 33 percent for the control group. “People tend to be conservative,” says Floyd Fowler Jr., president of the Foundation for Informed Medical Decision Making, in Boston. “Physicians tend to be more enthusiastic regarding surgery.”

Ultimately, there is a limit to the number of health-care decisions that will be influenced by cost and quality data. In an emergency, of course, stopping to evaluate information on health-care providers isn’t really an option. In addition, “if you look at the cost of health care, it is heavily skewed to the sickest patients,” says Margaret O’Kane, president of the National Committee for Quality Assurance, in Washington D.C. Ten percent of the sickest patients account for about 70 percent of all health-care spending, reports the Commonwealth Fund. Their conditions are usually complicated, and it’s rare that a single medical professional coordinates these individuals’ care, ensuring they get the services they need but are not subject to excessive treatment.

Most likely, greater transparency will slow the rate of cost increases in health care rather than actually lower prices, says Leavitt. The goal, he notes, is to cut the ratio of health-care spending to the U.S. gross domestic product. In the early 1950s, health care accounted for 4 percent of GDP; by 2006, it had quadrupled to 16 percent.

Getting there will take some work, Leavitt adds. People want to think that the system can move with the speed of a Formula One race car, he says. “But what we have is a pile of wheels, a small frame, and a lawn-mower engine, and we’ll assemble it into a go-cart.”

Karen M. Kroll is a freelance writer based in Minnetonka, Minnesota.

Where to Get Information

Employers can direct their employees to several sources of reliable information on health care. Most major health plans offer basic information on such common hospital procedures as coronary bypass surgery. At, for instance, Cigna members can find average cost ranges and patient outcomes on about 45 procedures. The information is based on data the hospitals report either to Medicare or state regulators.

Some state agencies also offer information on hospitals. Through Wisconsin PricePoint (, a subsidiary of the Wisconsin Hospital Association, a consumer considering, say, a knee replacement can check the number of similar procedures performed, average length of the hospital stay, and charges at his local hospital and compare that data with results for all other hospitals in the county and state.

Hospital Compare (, a joint initiative of the U.S. Department of Health and Human Services and the Hospital Quality Alliance, lets consumers check several quality measures at hospitals across the country.

In addition, a handful of independent sources help educate consumers. For example, Subimo ( or is a subscription-based service that lists hospitals’ experience and reputation for different procedures. — K.M.K.


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