Just how much responsibility and cost consumers are willing to carry when it comes to health coverage is the focus of this issue — September 2003. At it happens, 10 years ago — September 1993 — Managed Care looked at the consumer's role in grading physician performance. Cost borne by the enrollee wasn't an issue then; employers bought HMO coverage and copayments were minimal.
Measuring patient satisfaction was becoming a big deal, and I wrote our cover story for that issue on ways that physicians might improve their consumer ratings, so to speak. A small percentage of a capitation payment might ride in the balance.
Perhaps I should have labeled this page "Department of The More Things Change...." Patient satisfaction isn't heard as a term so much any more, but if you look at the various proposals for consumer-directed health care, it becomes obvious that enrollees are to be allowed, if not forced, to vote with their feet. If I were running a hospital or a physician group, I'd be paying attention.
Back in '93, the Clinton plan was causing a lot of commotion. In that cover story, I wrote:
"Should managed competition and a uniform benefit package become law, managed care organizations will have to compete on the basis of cost and quality. Plans that provide high clinical quality to satisfied patients will score higher on the much touted national 'report cards' for health organizations, which could allow them to charge higher premiums than competing plans, and be able to offer you higher payments."
That was then, and the specifics of that proposal are dead. But just last month, health economist Alain Enthoven told us that he hasn't given up on managed competition, that rising costs will force the system to finally try his way.
Those report cards — brought to us by the folks at the National Committee for Quality Assurance — have been with us for some time now. We are still trying to sort out just what their effect may be regarding how much health plans charge, and what they pay physicians.
In that article, 10 long (or is it short?) years ago, Alan L. Hillman, MD, MBA, currently chairman of our Editorial Advisory Board, questioned just how much patients can do.
"Certainly no one thinks that patient satisfaction fully reflects quality, because you can have doctors who have terrific interpersonal skills, great amenities, and perfect office hours who bumble and fumble their way through the technical aspects of medicine and make all kinds of mistakes," Hillman said in 1993.
"You're going to have to distinguish between the patients' perception and what actually happened. Patients are not qualified to make judgments about the technical quality of their care."
Even back then, though, some people insisted that one need not be an expert to be able to make many health care decisions.
"What I've read and what I've experienced myself suggest that patients are probably a pretty good source of information about medical outcomes and that patients tend to be reasonably appropriate in terms of linking satisfaction with outcome," said Cary Sennett, MD, then an official with U.S. Healthcare (this was before the merger with Aetna).
Maybe we have moved on. Ten years ago, consumers were seen as hard-to-pin-down databanks that health plans might mine to judge how much to charge for benefits, and to pay physicians. These days, information flows both ways. — John Marcille, Editor