Historically, patients choose doctors for reasons other than quality. 

According to a Harris poll, these are the top reasons considered when selecting a physician—along with the percentage of respondents. 

1. Whether physician covered by health insurance plan—72%
2. Office location—69%
3. Hospital affiliation—49%
4. How long it takes to have an appointment—47%

Not doctor training.  Not outcomes.  Not avoiding ‘red-flags’ like prior lawsuits or penalties by the State Medical Board. 

In contrast, as a physician my primary reason for selecting a doctor is Competence.  When my doctor friends ask each other for a recommendation for themselves or their families, they also seek Competence.   

What doctors mean by ‘Competence’ is: ‘The physician in question uses best practices in diagnosis and treatment that have typically be proven by scientific research.’ 

Examples of competence include: 

1. A primary care doctor that adds a second blood pressure medication when a patient’s hypertension is still not controlled on just one pill.  (Effective hypertension treatment requires 2 or more medications the majority of the time.)

2. A cardiologist who does NOT order a stress test in a patient just because they are ‘older’ or someone in their family ‘had a heart attack.’ (Stress Tests should only be ordered if a patient is having cardiac symptoms.1)

Aligning Health Insurance Plan Design 

In the above survey results, the top reason of ‘insurance coverage’ can be thought of as a proxy for out-of-pocket cost. 

Ideally, employer-sponsored health plans would align their health insurance plan design with physician competence.  Specifically, employer-sponsored health plans would align the out-of-pocket costs for plan members with physician competence. 

By using this approach, employer-sponsored health plans can make the #1 priority for plan members (i.e. out-of-pocket cost) align with the #1 priority that doctors use when choosing their own care (i.e. competence). 

Overcoming Location-Bias 

The above survey results also indicate that doctors’ offices are kind of like restaurants… consumer choice is heavily influenced by ‘location, location, location.’ 

However, unlike restaurants, the implications of a poor choice in doctors could result in a missed diagnosis, mistreatment and thousands of dollars in out-of-pocket costs—not just a bad meal. 

A ‘nearby’ doctor’s office location is a short-term convenience that can result in long-term negative consequences. 

So what to do? 

The typical health insurance plan design is so misunderstood by plan members (only 9% of people understand the basic elements of their health insurance coverage.2), that today’s health insurance plans do not incentivize what’s important—competence—over what’s easy—convenience. 

In contrast, employers can use the reason that is even more important than location to plan members—i.e. out-of-pocket costs–to direct them to competent physicians. 

An effective plan design can incentivize behaviors that are more beneficial in the long-term over those that are inferior, but more appealing in the short-term. 

Patients can make quality the top reason for choosing a doctor… and their health plan can make it happen. 

Sources: 

1. https://www.choosingwisely.org/patient-resources/ekgs-and-exercise-stress-tests/
2. https://www.healthcarefinancenews.com/news/more-americans-are-avoiding-healthcare-due-cost-uncertainty