Consumer Choice in Health Care: The Beginnings of a Market Driven System?

There have been large annual increases in the cost of health care in the past few years. Those increases have necessarily resulted in large increases in health insurance premiums. Employers (who pay most of the premiums for health insurance for their employees) have been hit hard by the escalating premiums. Employers have sought to shift more of the cost of health insurance onto their employees. They do this by requiring higher premium sharing, higher co-pays, or by offering only higher deductible policies. Some combine high deductible policies with Health Savings Accounts (HSAs). This type of change is supported by politicians and economists who theorize that consumers will have incentives to select lower cost and/or higher quality services when their own funds are at significant risk. Whether this will, in fact, curtail the escalation of overall health care costs is still an open question. Whether the public will accept and embrace this trend or will react against it (as they did with regard to strong controls imposed by health maintenance organizations in the 1990s) is also an open question.

For such a system to work, however, as with the market in any good or service, the consumer must have information on the price to be paid and the quality of the product. At least theoretically, the consumer can then make comparisons among providers and, hopefully, make wise choices. Currently, however, the health care system provides neither price nor quality-of-care information. What is the amount my insurer and I will have to pay for a mammogram? Which private pediatric practice has the most experienced physician  regarding childhood injuries? How much will I have to pay for a knee replacement? Which hospital has the best overall record regarding care for heart attack victims?

The health care industry is beginning to take small steps toward providing price and quality-of-care information. Some parts of the industry are more reluctant than others to do this voluntarily. We list here some websites that provide some level of price and quality-of-care information specific to New Hampshire providers. These sites will evolve and expand in coming months and new sites will join them. As you will see if you visit these sites, they are not yet the equivalent of either Consumer Reports magazine or Froogle. If market-driven health care is going to work, progress in providing easy-to-understand and easy-to-access information on both price and quality-of-care will have to accelerate in coming months.

The following New Hampshire websites are the best current attempts to provide quality-of-care and price information to consumers.

NHQualityCare  - quality measures comparing NH hospitals prepared by the Foundation for Healthy Communities and Northeast Health Care Quality Foundation

New Hampshire HealthCost - NH Insurance Department listings of typical prices and price ranges for some procedures and services

New Hampshire's Medicine Cabinet - price of prescription drugs at various pharmacies in New Hampshire

Dartmouth-Hitchcock Medical Center  - reports on this institution's quality-of-care

Dartmouth-Hitchcock Medical Center  - what they charge for certain health care services

We seek submissions of additional sites to be added to this list. The main criterion for inclusion is that the site have information that is specific to New Hampshire.