Patients and doctors, all dissatisfied

blankDoctors and patients have wildly differing perspectives on the health-care marketplace,  and yet they share a feeling of dissatisfaction.

Both constituencies were interviewed in a pair of newly released studies by the Robert Wood Johnson Foundation, Talking About Health Care Payment Reform with U.S.Consumers and Talking with Physicians about Improving Payment and Reimbursement.

The big takeaways from the patient report:

“1. This is not a conversation most consumers want to engage in.  …  The focus groups made it abundantly clear that consumers do not want to think or talk about how, when or why their health care providers are paid. They have little to no knowledge about how the current reimbursement process works, and linking money or payment to their health and health care makes them  uncomfortable at best, very angry at worst.  …
“2. There is a gender gap with this issue. In every focus group …  men were far more ready to consider quantifying the relationship in terms of care-provided-for-dollars-earned. Women, in contrast, almost always spoke of the relationship in much more personal terms, and repeatedly expressed concerns that data alone do not provide information on the patient’s personal experience with the doctor.  … Communications research has shown that women are typically a family’s gatekeeper to the health care system and choose doctors for family members. …
“3. While consumers don’t want to discuss payment and reform, they do want
changes in care delivery – and these changes open the door to the conversation. Patients want to spend more time with their physicians, and they want the care they receive from different doctors to be better  coordinated. …”

The big takeaways from the physician report, which focused on interviews with primary-care doctors:

“1. Physicians are extremely frustrated with the current health care system. Virtually every physician interviewed passionately expressed deep   frustration with the health care system in general, and their concerns about the inadequate reimbursement structure in particular. They feel squeezed by today’s payment system and pressured to see more patients, frustrated that they cannot give their patients the time they need because they are not reimbursed for much of the work needed to build a better patient-provider relationship or to adequately coordinate their patients’ care. They are aggravated by what they see as ever-growing administrative requirements, especially time spent supplying documentation for reimbursements, and payers interfering with care, e.g., insurers requiring authorizations for treatments. …
“2. Physicians are open to the idea [of] payment reform. Physicians recognize that rising health care costs are unsustainable and they are open to hearing about efforts to potentially change the way payment/reimbursement works. While the downsides of various payment reform experiments past and present still concern them – and they see the devil in the details – their level of frustration has seemingly made them more receptive to new ideas.”