Consumer Health Care Information

Rapid changes in the health insurance industry have spurred calls for greater information dissemination to enable consumers to make more informed choices. Purchasers of health care, such as large employers and agencies responsible for government employee health plans, have become more active in the information movement as they have adopted "value-based" purchasing strategies. For both purchasers and their employees, information is critical in choosing the highest-quality health plan for the dollar and in promoting efficiency and responsiveness in the provision of health care services. In September 1996, the President created the Advisory Commission on Consumer Protection and Quality in the Health Care Industry and charged it with recommending measures to promote health care quality and protect consumers and workers in the health care system. The Commission issued its initial recommendations in November 1997. This report (1) reviews the Commission's recommendations regarding information to be provided to consumers and compares them with the information now provided to employees of large public and private health care purchasers, (2) reviews the available evidence from purchasers and researchers concerning the extent to which consumers are able to make use of this information, and (3) discusses the potential cost of bridging any existing information disclosure gap between the Commission's recommendations and purchasers' existing practices.

GAO noted that: (1) the Quality Commission's Consumer Bill of Rights and Responsibilities recommends that consumers have access to a broad range of information regarding the policies, characteristics, and performance of health plans, professionals, and facilities; (2) under the Consumer Bill of Rights, each of these components of the health care system would have responsibility for routinely providing a set of specific information to consumers, either directly or through plan sponsors, and making other information available on request; (3) taken together, the large purchasers in GAO's review, and their associated health plans, currently provide over half of the data elements the Commission recommended be routinely provided to consumers; (4) the information covering conventional health insurance issues, such as covered benefits and cost-sharing, is typically provided by health plans; (5) in addition, performance measures reflecting plans' clinical quality and enrollee satisfaction are generally collected and disseminated by large purchasers; (6) on the other hand, information that the Commission recommended be provided about the business relationships and financial arrangements among health professionals, health care facilities, and health plans, as well as measures of service performance, are among the items not routinely reported to consumers; (7) to be responsive to consumers' information needs, large purchasers disseminate information through a variety of media; (8) written materials, generally used during open season to assist consumers in their health plan selection, are highly accessible but can become quickly outdated; (9) regardless of the format used, however, both the purchasers GAO interviewed and consumer surveys indicate that many enrollees do not use the health care information made available to them because it is difficult to understand; (10) according to an analysis performed for the Commission, meeting the Consumer Bill of Rights information disclosure recommendations would add $0.59 to $2.17 per enrollee per month to current information-related expenses, depending on the level of detail provided and the time allowed for implementation; (11) the cost increases would initially be borne by physicians, hospitals, health plans, and dissemination sources and could ultimately be passed on to purchasers and consumers; and (12) despite the potential increase in cost associated with providing more and better information, large purchasers indicated that they intend to continue expanding their information development and disclosure efforts because of the value gained through informed choice.