There is no shortage of insight into the patient journey as it relates to healthcare. So, let’s look at a recent survey that continues to shed light on patient preferences in selecting a provider.
As background, the 2019 Patient Access Journey Report is based on a survey of 1,000 US consumers conducted by Wakefield Research on behalf of Kyruus in July 2019. All survey respondents searched for a provider for themselves in the last two years and represent an equal mix of private insurance and Medicare or Medicaid respondents from four age groups: 18-34, 35-49, 50-64, and 65+.
It is always fascinating for me to understand the decision-making criteria that patients use when selecting a provider. Sometimes because of what we find. And sometimes because of what we don’t find. For example, this data set includes no information on respondent gender, ethnicity, educational attainment or household income (although insurance status may shed some light on this last aspect).
These demographic factors and social determinants of health can be important drivers of criteria in provider selection. Further complicating our potential interpretation of this data set is that we have no idea of the baseline health status of the respondents.
With those limitations understood, let’s examine the responses. In looking at figure 1, no one can be surprised that ‘insurance’ and ‘clinical expertise’ are ranked one and two respectively. After all, if you have to pay out- of-pocket for services for which you’re already covered (ie, the doctor doesn’t accept your plan provider) and/or your doctor isn’t qualified to help you, then nothing else really matters.
The problem with ascertaining doctors’ qualifications is that you don’t really know if they are any good until you’ve actually had your first visit. Which means that you’re probably using ‘online ratings and reviews’ as your surrogate marker. This introduces a whole set of other concerns.
After the top two responses, things get interesting. Communication skills as a criterion for provider selection is becoming more and more important. In 2017, this criterion was ranked sixth and in 2019, it’s third. Remember, this has nothing to do with the office staff’s communication skills. This is entirely the rating of the doctor’s communication skills.
The survey uses ‘bedside manner’ as a euphemism for communication skills, which can be interpreted to mean things like compassion, empathy and information exchange. What does this tell us? Perhaps, that the paternalistic days of the provider-patient relationship are long gone.
In those days, the hallmark of such a relationship centred on the provider telling the patient what to do with little to no input and largely ignoring any component of shared decision-making. Today, the quality of the interaction seems to be central to provider selection which, intuitively, probably includes more patient involvement in their treatment.
At the bottom of the list, is ‘number of years in practice’. A pretty innocuous criterion that would, in most circumstances, be ignored. In fact, 3/4 of respondents didn’t think this was an ‘extremely important’ element and, overall, 40% of respondents thought this was, basically, a non-issue.
One must wonder if patients are looking for more experienced doctors because they think it has an impact on their outcomes. Or maybe this criterion is less of a concern because patients who look for providers know that physicians with fewer years in practice are, naturally, younger and may be better communicators and may have practices that are not as busy and, thus, appointment availability may be less of a concern.
Cost is a bit of a red herring. It always is. To the extent that you’re unable to understand your total cost of care, it is surprising that this does not rank higher. To the extent that you have private insurance with a low co-pay or that you’re covered under the public purse, this is unsurprising.
And, of course, cost is related to baseline health. Presumably, if you’re looking for a healthcare provider, it’s because you need one. But is it for an acute situation where the cost has a finite amount and an end in sight? Or is it to manage an ongoing chronic disease?
It is fair to say that each criterion could form an entire article on its own and the point is not to closely examine each of them in mind-numbing detail or to pick on the methodological issues of small surveys like this (there are many).
The point is to build directional insights that are important. To look at the end user’s point of view, which is crucial. And, most importantly, to remind ourselves that when we reveal patient preferences, we are on the road to building a better healthcare system.