Ethical questions about consumer-driven health care plans and marketing thereof

The marketing of these plans makes my skin crawl. “Put the consumer in the driver’s seat…give consumers the tools to make smarter decisions.� All noble goals. None ready for prime time yet.

Last week’s Journal of the American Medical Association published a commentary, "Consumer-Driven Health Care Might Not Be What Patients Need -- Caveat Emptor" by Robert Berenson of the Urban Institute and Christine Cassel of the American Board of Internal Medicine.

They write that the consumer-driven health care plan model "implicitly calls for a fundamental reordering of the patient-physician relationship, placing increased reliance on commercial ethics while eroding professional ethics as the guiding force for patient-physician interactions. ….

The consumer-directed health care goals of information sharing and involving patients in care decisions and in the societal need to manage scarce health care resources should be endorsed. But the notion that the way to achieve these goals is to further pit physicians and patients against one another as market suppliers and customers who aim to foster efficiency out of a competitive drive cannot be accepted.�

Meantime, last week at Consumer Reports in New York, a group of people interested in online health communication issues listened to a panel that discussed the potential – but mostly the flaws – of one set of consumer-directed tools – the current online ratings for hospitals and doctors. For example, Avery Comarow of U.S. News & World Report, who manages the magazine’s annual “America’s Best Hospitals� report, says they only started doing those rankings because the industry hadn’t. He talked about how “messy� and “incomplete� was the business of compiling these rankings. He said no online site has enough patient data to make a valid physician rating

Panelists talked about hospitals and doctors learning how to “game� the system to make their statistics look better than they really were.

Those were just a few of the issues raised that indicate how far we are from having some of the tools that consumer-driven health plans promise.

Dr. John Santa, who heads Consumer Reports’ Health Ratings Center, says that until there’s a level playing field in the health care marketplace, true consumer-driven health care won’t exist.

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Maggie Mahar has also blogged about why patients don’t use provider ratings systems and why that's “more bad news for consumer-driven health care.�