The Health-Care Industry’s Relationship Problems

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When I became a doctor, last year, I had to sign up for health insurance. The hospital where I work offered two primary options, a Value plan and a Plus plan. One cost less up front, while the other promised more benefits.



I didn’t know which to choose; after factoring in co-pays, deductibles, and variations in coverage across networks of doctors, it wasn’t clear which would be more economical. Ultimately, I enrolled in the Plus plan, the product of guesswork more than reason.
At the start of November, the open-enrollment period for plans on U.S. health-insurance exchanges will begin, and millions of Americans will face a similar struggle. As consumers, we’re accustomed to making informed choices about what food to eat, what car to drive, what school to attend. But health insurance is a striking exception. Only one in seven Americans understands the basic components of a health-insurance plan, according to a study published a few years ago in the Journal of Health Economics. That means most of us are signing up without knowing what we’re getting or what it’s worth.

Health care is especially complicated to purchase because it’s consumed differently from just about everything else. If I want a cheeseburger or a haircut, I can pay someone who makes cheeseburgers or cuts hair. But as a patient, I don’t necessarily choose the care I receive. My doctor decides which tests to order, medications to prescribe, and procedures to perform. In most cases, I also don’t pay for those services in full; my insurer covers part of the expenses. This creates a strange dynamic. Doctors, under a traditional fee-for-service model, are rewarded for providing more care, while insurers have incentives to restrict coverage. Meanwhile, most patients, despite being the ultimate consumers, lack a direct relationship with insurers. Instead, the interactions tend to be at best transactional and at worst confrontational. Attempts by insurers to create brand loyalty and improve outcomes by forming relationships with patients and influencing their behavior—persuading them to exercise more, smoke less, or take their medications, for example—have met with limited success, whether because patients don’t trust advice from insurers, don’t know how to access information, or simply aren’t paying attention. continua a leggere 


Rena Xu, The New Yorker

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