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Health care decisions take active participation

Whatever you pay for your health care, chances are good that it’s going up. The basic costs of procedures and services have been rising steadily for years. Employers have been scaling back their contribution to insurance coverage, raising deductibles and reducing coverage on workers. As layoffs put more and more people out of work, they’re faced with the possibility of footing the entire bill for their medical care. Consumer advocates are urging people to take a more active decision-making role in their health care to try and bring down costs without compromising care. But others caution that consumers are sometimes in a poor position to make decisions that affect their health, operating on limited information and with limited understanding. “Health care is unique. You can’t simply compare health care to buying a car or a TV,” said Fevzi Akinci, a researcher and associate professor of health policy and administration at Washington State University in Spokane. “Consumers are in a difficult position to judge the quality of the information.” Still, given the realities of the health care market, he said, “We have no choice but to become educated consumers of our own health care.” The idea of consumers “taking charge” of their health care has flourished, especially as concerns over the economy and cost-cutting have grown. Some consumer advocates say the model of a passive patient no longer works; they emphasize the long-term savings for individuals and the overall system associated with healthy habits and preventive care. But they’re also encouraging people to get involved at a more detailed level – negotiating with your doctor or hospital for lower prices; scouring bills for mistakes; seeking care at clinics or through nurse practitioners; and comparison-shopping for everything from surgery to prescription drugs. A University of Minnesota project – titled “Taking Charge of Your Health” – puts it this way: “Instead of acting as a passive recipient, many people now see themselves as active participants in the purchase and application of health care. They are selecting skilled professionals to be part of their health care team, and they want to partner with these providers.” The issue of consumer choice in health care has been around for years as a political question. Conservatives have long argued that giving patients more choice and control over their health spending would help bring down costs; liberals have proposed variations on government-sponsored universal coverage to help insure the roughly 46 million people without coverage and manage costs. But the recession and rising health care costs have highlighted the issue in purely consumer terms. “Millions of consumers are weighing their medical costs and trying to see what expenses they can jettison to save some money,” Cathy Tripp, a senior consultant in the Minneapolis office of benefits consulting firm Watson Wyatt, told the Los Angeles Times. A Watson survey of 2,500 U.S. employees released in January found that 17 percent of them had avoided a recommended doctor’s visit in 2008 to save money. The same percent chose not to fill a prescription or skipped doses of medicine. Meanwhile, a separate Watson survey found that a fifth of companies surveyed had raised employee contributions to their health insurance in 2008, and that another quarter planned to do so this year. A decade ago, employers covered about 90 percent of workers’ health care costs; that’s projected to drop to 70 percent in the next few years, according to the Benefits Roundtable at the Corporate Executive Board, a research and analysis firm. Akinci said people tend to be uninformed and passive about their health care until a crisis, and that it’s been difficult to change that. For years, employers and health plans have been emphasizing “health and wellness initiatives” aimed at getting people to adopt healthier lifestyles. Businesses have had a particular interest in the initiatives, as they’ve been pinched by rising premiums and associated costs, such as absenteeism, according to a brief from the Center for Studying Health System Change. Many employers and health plans have tried offering a wide range of incentives for people to make healthy change and, less commonly, have begun adding “sticks” – such as increased costs – for those who don’t. There’s little evidence about the effectiveness of such programs, the brief says, and a sense that some people resist them. A 2007 survey found that nearly half of respondents felt wellness programs, which ask questions about fitness and health habits, intrude on worker privacy, the brief says. A report by the American Institutes for Research found some obstacles to consumers being able to evaluate and act on information about the quality and cost of medical care. The report found that many people are unfamiliar with or mistrustful of sources of medical information beyond their doctors; that consumers are especially suspicious of employers’ motivations in restricting coverage; and that they simply weren’t sure how to become more involved. Plus, “being actively involved can be just plain hard,” according to a summary of the report. Akinci said that the range of information out there is expanding – noting that the Centers for Medicare & Medicaid Services Web site includes comparative information among nursing homes, for example. The site also has information on the cost of several common hospital procedures. Other Web sites offer similar information about health plans and medical costs – although they take a little work to sort through and understand. He also said there may be a downside to consumers making more decisions on their own. While some information is available, much is not. Medical judgments require a level of knowledge that many people simply do no have. Research suggests that people enrolled in high-deductible insurance plans with health savings accounts to cover their out-of-pocket costs may skip or delay important preventive treatments like mammograms, he said. Often, people simply don’t start paying attention until a catastrophe arises. “We wait until the last minute – and then suddenly we become educated consumers,” Akinci said.
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