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Evidence October 2007

Brief 6 of 6

issue brief
In February 2007, AcademyHealth conducted a meeting on behalf of the Robert Wood Johnson Foundation examining the role of consumer engagement in improving the quality of health care. In preparation for this meeting, five papers were commissioned on the following subjects: consumer activation, consumer choice of health plan and provider, consumer choice of treatment, patient navigation, and the appropriate role for consumers. This issue brief is based on the consumer choice of health plans and providers paper, which was authored by Jonathan Kolstad and Michael Chernew, Ph.D.

Consumer Choice in the Health Insurance and Provider Markets: A Look at the Evidence Thus Far may or may not be evidence-based. Because consumer choice of health plans and providers drives cost and quality outcomes, consumers are being asked to make use of these formally reported data as they assume greater responsibility for their health and health care decisions. Despite the momentum in this area, it is not easy for consumers to make evidencebased decisions about their health plans and providers. There are several reasons for this. First, there is a relative dearth of information on quality. Second, choosing between health plans is not as simple as it once was because there is no one-size-fits-all or “right” answer. Third, out-of-pocket costs are increasingly a factor. Consumers are also at a distinct information disadvantage when it comes to choosing providers, since they lack clinical knowledge and may not understand the full spectrum of factors that should be weighed in the decision (e.g., years in practice or board certification). However, consumers do not act alone in making these decisions, and the choices available to them—for health plans and providers—are sometimes limited. For example, employers affect the choice of health

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