More money, more problems: Employees feel little to no responsibility to curb health care spending, even as costs rise

As effective dates for health care reform and the opening of state exchanges loom larger on the horizon, it’s clear that making employees better health care consumers is speeding up employers’ priority lists. In this undertaking, one of the biggest challenges is breaking down the difference between care quality and costs (as well as how the two are linked)—especially when employees come to the table with preconceived ideas surrounding health care.

A recent survey published in the journal Health Affairs reveals that the majority of people object to doctors focusing on costs. Survey co-author Susan Dorr Goold, a professor of internal medicine and health management and policy at the Center for Bioethics and Social Sciences in Medicine at the University of Michigan, recently sat down with Michelle Andrews of Kaiser Health News and pinpointed 3 common employee attitudes toward making health care cost decisions:

1. Whatever it takes. The majority of patients don’t want to factor costs into their medical decisions, nor do they want their doctors to do so, the survey finds. In fact, most patients are unlikely to accept a less expensive treatment option, even if it’s nearly as effective as a more expensive choice. Doctors feel the responsibility to help contain health care costs but feel even more responsibility to their patients. If patients won’t consider it, they put doctors between a rock and a hard place.
2. Confusion over the basics. Participants generally do not understand how insurance works and feel little personal responsibility for helping to solve the problem of rising health care costs. This is confirmed by findings from the third annual Aflac WorkForces Report, which reveal that 89% of workers choose the same benefits year after year—and many don't understand the options provided.
3. You get what you pay for. Goold has come across this American, market-oriented point of view many times. For example, when discussing generic versus brand-name medications with patients—though there is rarely a difference in value—many people resist a cheaper option, even if it’s just as good.

Among other survey findings:

• Participants don’t want physicians to factor in patient resources when they make treatment decisions.
• Participants feel that, since they’re paying health insurance premiums, they should be entitled to unlimited care whenever they need it.
• Participants are unwilling to make any tradeoffs between health and money, no matter how expensive the treatment.
• Some participants seem motivated to choose expensive care “out of spite,” because they were antagonistic toward their insurance company.

So, employees are feeling spiteful, entitled, distrustful and confused about health care. No wonder communicating with them is so hard! Adding to employers’ challenges, employees are reading about health care from different sources and are becoming overwhelmed by the different information and messages they’re receiving. A recent study reports that 54% of U.S. workers prefer not to have more control over health insurance options, because they see making such decisions as too daunting.

To ease the communications burdens for employers and employees alike, workers need clear and digestible health care information, fast. In light of upcoming health care reform changes, it’s even more important that your employees have access to the best tools to navigate the new and ever-changing health care system.

That’s why we’re excited to be involved with Choosing Wisely, an ABIM Foundation initiative with resources from the trusted Consumer Reports brand. Choosing Wisely focuses on the importance of the quality of care and provides numerous resources explaining why. From tip sheets to videos to a complete ready-for-use Employer Toolkit, Choosing Wisely provides engaging, straightforward communications for your employees.

Do these attitudes align with what you’ve heard from your employees? Have you checked out Choosing Wisely yet? Be sure to visit the full list of resources below.

Resources

Choosing Wisely press release­­­­

NBCH’s Choosing Wisely website for employers

Consumer Reports’ Choosing Wisely resources for employees