Choice of Doctors — what is choice worth?

multiple choice

How much extra are you willing to pay to continue to see your current primary care provider?  $100 per visit? $20 per visit, or $2 per visit?  That’s an individual decision.  But, insurance industry  studies show an average person in a health plan would change primary care providers if they had to pay more than $2 extra.

correct answer

This is one of those dichotomies where people rate choice of providers very highly but in practice are not willing to pay more than about $2 to pick one provider over another.  Doctors uniformly place a much higher value on the doctor-patient relationship than patients themselves.

However, to paint the picture with a large brush leaves out details.  Patients who have primary care providers that manage chronic illness like diabetes, asthma or migraine headaches are much more willing to pay higher co-pays to maintain that relationship.  Sometimes the relationship with a specialist is worth more to patients, but not always, because of a prevailing notion specialists are more alike than primary care providers.

The $2 statistic also includes the huge number of people who do not see a health care provider regularly — they just go to a clinic when a problem arises.  In fact, they just want to be seen quickly, the name of the provider is not important.

Over the past 10 years employers have changed insurance carriers on average every 3 years.  A change in insurance often forces people to change providers in order to stay “in-panel” and avoid high out of pocket costs.  Anna Wilde Mathews’ article “Health Plans Limit Choice of Doctors” appeared in the Wall Street Journal today (8/15/13).   She suggests the Affordable Care Act causes patients to change health care providers, an assertion that has no relevance, since that’s how our current system works!   Not to say this is good — in fact, forcing patients with chronic illnesses to change providers borders on unethical business behavior.

Conclusion:  rather than whine about the Affordable Care Act we need reasonable legislation to improve US healthcare, NOT legislation to return to something worse.   Businesses should not have to change health plans so frequently.  We need more large high functioning health plans (like Kaiser Permanente and a few others)  so businesses don’t feel the need to change insurance carriers so patients can keep the health care providers they like.

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