Quality and Consumer Decision Making in the Market for Health Insurance and Health Care Services

Report cards on health care plans and providers have become common because it is hoped consumers who have access to information on quality will make good choices, leading to better financial and health outcomes. This article synthesizes a broad span of studies since 1997 that examine the link between quality and choice, and the extent to which providing consumers with more information on quality influences their health care decisions. This review finds people do opt for higher quality choices; but this varies by population group and the effect of report cards may be small.

Key Findings:

  • Consumers seem to opt for better quality health plans and providers even when report cards are not available.
  • A modest portion of consumers who had report card information available did review it and react to it.
  • Consumers react to quality information and select plans and providers differently depending on their socioeconomic status, race, ethnicity and gender.
  • Limited study of whether employers respond to health care quality shows: larger employers were more likely than smaller employers to have data on quality available and to use it in health plan choice; and employers’ decisions to make higher quality plans available are responsive to employee preferences for those plans.
  • Consumers believe price equals quality in health care, until they see data that contradicts their assumption. Consumers are consistently willing to spend more to move up from the lowest quality plans to the average, but are less willing to pay to move to an above average plan. Similar patterns are seen with provider selection.

The article cites more than 75 references from medical, economics and health services literature. Despite that breadth, the authors conclude there are many unanswered questions. There are too many gaps in the existing literature to determine whether providing information about plan and provider quality will prompt consumers generally to make better choices in the marketplace, nor is it clear how and when to release information to have the greatest impact on consumer choice. The authors further worry that even the study results observed so far may not be valid in an environment where consumers are asked to pay substantially more for health care as they may be in the future.