Doctors, not report cards, shape consumer choices

Despite the prevalence of ratings and report cards, physician recommendations about health plans, hospitals, or other providers continue to be patients’ most valued resource, according to a recent survey.

"Americans are really turning to [their physicians] and trusting their opinions," says Mollyann Brodie, PhD, senior researcher and director of special projects for the Kaiser Family Foundation in Menlo Park, CA. "They’re valuing those recommendations above any expert evaluations."

In a 1996 national telephone survey of 2,006 adults, consumers cited "a regular doctor" as the most influential source of recommendations on health plans, other doctors, or hospitals.

Recommendations from family or friends formed the second most influential source of health care information, according to the survey, which was sponsored by the foundation and the federal Agency for Health Care Policy and Research (AHCPR) in Rockville, MD. It was conducted by Princeton (NJ) Survey Research Associates.

The survey shows that consumers are not ready to rely on report cards, expert ratings, and published outcomes measurements for their health care decisions, Brodie says. For example, 76% of respondents said they would choose a surgeon who had previously treated their family without problem over one who had higher independent ratings.

"People think the [health care] marketplace is going to be changed by consumers making decisions [based on report cards]," she says. "This survey proves we are so far away from that actually being the case."

However, physicians may benefit from outcomes-based evaluations, which they could use in making recommendations to their patients, she notes.

Sandra Robinson, MSPH, acting director of the Center for Quality Measurement and Improvement at AHCPR, is encouraged by the finding that 39% of respondents had seen information comparing the quality of health care plans, doctors, or hospitals within the past year.

"The most positive aspect of this [survey] is that people really want more information about quality," she says. "They value quality and they can discriminate between quality and access to services."

For example, consumers said the quality and range of benefits in their plans were more important than cost. Other findings included:

• In choosing doctors, consumers say they are most influenced by how well a doctor communicates with patients and shows a caring attitude.

• Only half of Americans have a choice among health plans.

• The majority of Americans believe doctors have more influence over the quality of health care than do health insurance plans.

• Americans say they would be more influenced by patient surveys and ratings by an independent organization.

[Editor’s note: To order a free copy of Americans as Health Care Consumers: The Role of Quality Information, contact the Kaiser Family Foundation at (800) 656-4KFF.]