America’s legislators have found themselves floundering for an economically tenable solution to the healthcare crisis. Consumer driven health plans (CDHPs) represent a proposed solution based on America’s constitutional, liberal roots. The success of the consumer driven health movement relies on the anticipated benefits of better informed healthcare consumer choices and increased associated responsibility. CDHPs—with lower monthly premiums and higher deductibles than traditional plans—should incentivize enrollees to become better-informed, prudent consumers of healthcare by searching the Internet for the cheapest and best providers, insurance plans, and medications. In turn, healthcare costs should decrease and quality of care should increase as providers compete for patients.
Potential enrollees’ competency to make informed decisions regarding the following five tasks critical to CDHPs were assessed: 1) enrolling in CDHPs, 2) becoming better symptom-based medical decision-makers, 3) learning about preventing and managing common chronic conditions, 4) locating high quality healthcare providers, and 5) curbing spending on medications. Twenty volunteers (10 English-speaking, 10 Spanish-speaking)—all without health insurance, from varying sociodemographic backgrounds—participated in observational usability testing using screen capture software, Morae 2.0. The average Flesch-Kincaid reading level and consistency of information presented on four popular health Infomediaries was also assessed.
The results suggest most potential CDHP enrollees don't have the adequate skill sets or online tools to effectively and safely make the informed decisions associated with plan usage. The Infomediaries provided fairly consistent information, but had a mean Flesch-Kincaid grade level of 10.1, well above the recommended sixth to eighth grade level. Most participants used search engines’ sponsored links that led to poor quality websites. No participants used the government-produced healthfinder.gov. Home computer access (p=.01) and increased years of education (p=.02) had statistically significant positive effects on performance of the tasks. Age, gender, and primary language were not significant.
The renovation of healthfinder.gov, health infomediary websites, a free educational program based in public libraries, and a call for greater responsibility by search engines with regard to sponsored links should result in a more just system that is likely to result in delivery of better quality healthcare in America and greater respect for patient autonomy.