Culture of Health Blog

State policymakers have more flexibility than ever to advance health-promoting policies and programs, and to showcase effective strategies from which other states—and the nation as a whole—might learn. RWJF helps inform their efforts through research and analysis, technical assistance and training, and advocacy.

In Europe, rich and poor kids alike are enrolling in early care and preschool programs in large numbers. These accomplishments offer us insights for our collective efforts to strengthen early education in the U.S.

Healthcare professionals, patients, and allies across the nation are banding together to promote an understanding of what good medical care can and should be with RightCare Action Week.

With convenient weekend and after-hours care, retail clinics have the potential to expand access to basic primary care and help address some non-clinical needs underlying the social determinants of health.

My husband and I recently bought our first house in Princeton, N.J. We had looked at several houses, all within a similar price range. But price wasn’t the only factor, and simply having a roof over our heads wasn’t our only goal. We wanted a place that allowed us to walk to town and had a yard for the kids to play in, as well as a garage and storage space. We didn’t care so much about some things that might be important to other people, such as the size of the bedrooms or any particular architectural style. Figuring out what was most important to us, what would be a high-value house for us—the people who would be living in the house—was just part of the process.

Just as people have widely varying preferences when it comes to a home purchase, they also have very different preferences and priorities when it comes to their health care. For example, I might prefer a primary care doctor who has weekend and evening hours, whereas my mom might prefer one who has a reputation for spending more time with patients. At least right now, Mom and I just care about different things.

What does “value” in health care mean to consumers generally—and not just consumers overall, but consumers of many different backgrounds and perspectives? What matters to people when they are choosing their health plan, which doctor to go to, or whether to go to a retail clinic, and what might make for a high-value experience in different health care settings? It’s hard to know, because today value is typically measured more from the perspective of payers and providers.

So that is why, this week, the Robert Wood Johnson Foundation and AcademyHealth, released a call for proposals to better understand what factors are most important to consumers when they make health care decisions.  

In building a Culture of Health, we realize “value” won’t mean the same thing for everyone, any more than it does when you’re buying a house. But unlike in home buying, we don’t have many tools and supports in place to help people make their own high value decisions. In health care, we don’t have enough information about what people care most about. This is what we want to find out.

Everyone knows it is hard to get 2-year-olds to do anything on a schedule. They want to do everything their way, on their own time. As you can imagine, trying to get my twins out the door each morning—let alone take a bath or eat a meal, can be quite a challenge. After trying a number of different parenting methods, I have discovered that the one way I can usually motivate them is to talk about feelings, and get them to recognize how their actions affect their sibling. Just yesterday, the only way I could get my son out of the bath was by telling him that his sister was sad and lonely waiting for him. And then, and only then, did he move.

Building empathy has been a critical strategy in my household of late—not only because it helps motivate them, but also because it is an important part of their social development. Lately I have been thinking about empathy on a larger scale, beyond my household, and how critical it is to building a Culture of Health.

While I knew that having children would turn my world upside down, I assumed that this transition would be more metaphorical than literal. Ha! Moments before I was discharged from a Maryland hospital a few days after my twins were delivered by c-section, the ground shook violently. My husband had just left the hospital room to get the car, so I was alone with two newborns and a painful surgical wound. All I could think was ... “This is an earthquake! I have two babies. And I can’t move!”

One of the scariest parts of the experience was that I couldn’t respond to my maternal instinct to quickly pick up and protect my babies because I had just had major abdominal surgery. Granted, managing in an earthquake is not a common part of recovery from a C-section, but there can be many other dangerous complications that occur more frequently, such as infection, emergency hysterectomy or heavy blood loss. It can also lead to greater difficulty with breastfeeding. C-sections are also very costly, even if there are no major complications. They are much more expensive than vaginal delivery.

“Pay no attention to the man behind the curtain! The Great and Powerful Oz has spoken!” 

In some ways, our health care system has traditionally functioned much like the fantastic land of Oz depicted in one of my favorite movies.  Consumers and purchasers are expected to be passive consumers, doing what they are told and paying whatever price is levied based on a high degree of trust and limited information. This model seems increasingly ridiculous. We now face an urgent need to improve the quality and efficiency of our health care system.

But to do that, we need information, a lot of information. Health professionals, purchasers, consumers—basically anyone who comes in contact with health care—need timely, accurate, comprehensive information on cost and quality if they are to make smart decisions. Without such information, not even a wizard could do the trick. But right now, such information is usually unavailable, or, when it is accessible, too often indecipherable. In fact, the Institute of Medicine estimates that $105 billion is wasted every year in the U.S. because of a lack of competition and excessive price variations in health care, and a lack of information on the price of health care services plays a large role in this waste.