Information about
Health-Care Providers
Trudy Lieberman
Consumers Union
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I. Conventional Wisdom
Going back to the early days of the
consumer movement which dictates
that if only consumers had good
information, the market place would
work better, maybe even perfectly.
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Conventional Wisdom (cont.)
• All we had to do was put labels on products warning of
dangers or disclose how a product worked or perhaps even
how much the true cost was.
• If we told people that supermarkets or restaurants had
insects or rodent infestations, they would clean up or lose
business.
• All of their efforts assumed that the consumer was king or
queen and by voting with their feet they could make a
difference in the marketplace.
• This is a very powerful assumption that fits with our free
enterprise ethic.
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II. Fast Forward These Beliefs…
to health care in the early 1990’s when it becomes
clear we weren’t going to reform our health system.
Attention suddenly turned to consumer information
in health.
If we couldn’t make the system better either
legislatively or through the regulatory process, then
maybe consumers could by voting with their feet choose the best hospitals, doctors, HMOs, and
nursing homes.
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III. Problems with this Notion
• The underlying assumption is that the same product
works for everybody, that health care is like buying a
toaster.
• Second difference is that buyers of toasters, cars, or
washing machines were skeptical about the marketplace.
They have concerns about manufacturers and retailers
and whether they were getting an honest deal.
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Problems with this notion as
it applies to health (cont.)
• The information movement, if you can call it that has, run
into a very entrenched medical establishment that resists
change. Public disclosure is not something they like and
are not terribly receptive to having consumers or patients
questioning them.
• Consumers of medical care are not always in a position to
choose products and services.
• It’s not realistic to think that even a few educated
consumers, if they had the right information, can make
hospitals or nursing homes better and safer.
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Reaction to Vincent Mor Paper
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VI. Need Out-of-the-Box Thinking
Even if we assume that the metrics for
hospital and nursing home quality are
the right ones - can we just put up a
web site and hope consumer get it?
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Thinking out of the box in
terms of dissemination
• We might look to the techniques of the agricultural
extension service in the early 20th century that
taught farmers about crops and their wives about safe
food preparation and other things.
• One on one meetings and counseling
• Group meetings and workshops
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VII. Unintended
Consequences of Information
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