Spending dollars without sense: How employees make health care decisions, and how to change it

Flummoxed by how your employees make their health care decisions? You're not alone. Whether it's lifestyle choices, or care and treatment choices, their decisions have an impact on your company's health care costs.

Once your company has selected an insurer and health plans for your employee group, the games begin. Employees are deciding where to go for treatment or surgery, racking up thousands of dollars in claims. Are they making their choices based on the costs to the company's insurance plan? Not likely. There are a lot of theories on how their decisions are being made, but cost is not one of them.

In fact, when a 2005 Gallup health care survey gauged the impact 10 characteristics have on respondents' decisions, cost was not one of the characteristics listed.

Consumers of health care services are not like most other consumers. Employees don't, and can't, compare prices before they buy. Try finding out a cash price for a diagnostic colonoscopy or robotic prostate surgery. Contrast that decision with deciding which lawn mower or gas grill to buy.

Do you ever wonder how the quality of service at a hospital would be affected if patients really knew what it cost to provide the care that they require? My guess is that we'd all likely demand much better service from a hospital if we knew that room-and-board charges for an ICU room alone were about $1,500 per day. Can you imagine what the service might be like at a hotel charging that much for a one-night stay?

In the same 2005 Gallup poll, the two biggest factors in patients' choosing one facility over the other were the expertise in a particular area and the incidence of medical errors.

What if hospital ads highlighted their near-zero infection rates or the fact that last year they had no surgical errors? That's information that is critical to any patient's stay, but unless you're Sherlock Holmes, it, too, is not easy to find.

What if ads for joint replacement surgeries presented the actual number of hip or knee surgeries that have been done and by which surgeon? A regional cancer center in Pennsylvania has now begun, in its ads, to publicize its five-year survival rates for their treatment of certain cancers. Talk about truth in advertising!

Even in the Internet age, your employees do not have access to the resources they need to make informed decisions about health care facilities based on the criteria they would most like to use. There remains a strong, unsatisfied demand for understandable information on quality of care and incidence of medical errors.

In the meantime, encourage your employees to have a conversation with their physician. Trying to select the right hospital for open heart surgery or a baby's birth is much easier when someone can educate you about what qualifies as optimal care.

And lastly, when considering a surgery or procedure, employees should insist on asking for data from the hospital and the physician. Questions such as "How many of these did you do last year?" and "What was the success rate?" are important. If a provider is unwilling to have that conversation, consider seeing someone else who will.

Contributing Editor Betty Long is a registered nurse and founder of Guardian Nurses Healthcare Advocates, a health care advocacy firm that has helped thousands of patients navigate the health care system and saved millions of dollars in health care costs.

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