Health Care Consumer Choice
The Role of Information
Catherine G. McLaughlin
University of Michigan
Choice is a highly prized commodity in the United States. The freedom to choose is fiercely protected. Recently health care consumers have felt as though their freedom to choose has been threatened: when they seek care, from whom, and how often; the site of treatment, whether inpatient or outpatient; whether they can spend a third day in the hospital after a normal delivery; whether they can purchase generic rather than brand-name drugs. Rightly or wrongly, they blame a lot of this loss of freedom on the growth of managed care. We are witnessing a plethora of articles and stories in the mainstream press, on television, even in movies like As Good As It Gets, as well as testimony at federal and state legislative committee hearings debating Patient Bill of Rights legislation.1
What most people may not realize is that before a consumer, a patient, ever reaches an individual health care provider’s office to discuss a particular diagnosis and treatment, a myriad of decisions have been made—decisions that influence the selection of the provider, the treatment, and how much the treatment will cost the patient. The typical health care consumer faces a road map of options, and the consequences of taking one option instead of the other are always attached to those choices. In many cases, when consumers make one choice, they are getting on a one-way road with that choice leading to future constraints.
As illustrated in Figure 1, for some adults the first choice that may in part be conditioned on an individual’s desire for health insurance coverage is whether to enter the labor market. The role played by Medicaid in the welfare-to-work decision is frequently discussed. Less attention is paid to the effect of health insurance coverage on other