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The Health Reform Vulnerable Americans Really Need

These consumers feel disrespected by doctors and lack information

By Richard Eisenberg

As Congress and the Trump-administration-to-be scope out possibilities for replacing The Affordable Care Act, here’s one area that needs attention stat: getting vulnerable Americans better health information about their options and costs and treating them with more respect. Findings from a new study on the subject could make your blood boil.

Health Information
Credit: Getty Images

“We’re not suffering from a lack of health care information,” says Chris Duke, research director of Right Place, Right Time: Improving Access to Health Care Information for Vulnerable Patients. “There’s a lack of targeted health care information. We need to move toward a system that pushes relevant, salient information to people at the right place and the right time.”

Here’s why he says that: Altarum Institute, the Oliver Wyman health care consultancy and the Robert Wood Johnson Foundation surveyed more than 4,000 consumers, focus-grouped 65 and spoke to roughly 100 executives from health insurers, health providers, employers, nonprofits and venture capital firms. Their focus was on lower-income consumers, Medicaid beneficiaries, the uninsured, caregivers and Spanish speakers. They found:

  • About 50 percent of vulnerable consumers, and 70 percent of the uninsured, are not satisfied with health care cost information. “Incentives are still not in place to make cost comparisons understandable,” said Duke.
  • Only 42 percent of survey respondents had used patient reviews of health providers. “Of the 65 consumers we interviewed, I don’t think a single one knew there were health quality comparisons available,” said Duke. (Similarly, as Helaine Olen recently wrote on Slate, a Harvard Medical School study found that few employees at two corporations who were given health care measurement tools actually used them.)
  • Nearly 40 percent of low-income consumers in poorer health felt disrespected by doctors.
  • Almost half of Spanish-speaking respondents said language barriers present a problem when communicating with doctors. Hispanics, the report said, are the least likely of all racial and ethnic groups to see a doctor.

Not only would dealing with these problems be humane, it would likely make vulnerable Americans healthier and reduce their health costs.

The High Cost of Disrespect

The study found, for instance, that patients feeling disrespected are twice as likely as others to not take their medications as directed. People with diabetes  who don’t feel respected are one-third more likely to have poorly controlled diabetes than those who do feel respected by health providers, said the report.

In one case, the doctor of a woman with high blood pressure abruptly and curtly told her to take medications three times a day, leaving without asking how she was feeling. “If he didn’t touch or look at me, how would he know what’s wrong with me?” Duke, a senior analyst with Altarum Institute’s Survey and Patient Engagement Research Group, said the woman told the pollster. Feeling disrespected, the patient didn’t take the pills. “When you’re not treated well, you’re less inclined to want to do what doctors have to say,” said Duke.

Struggling With the Internet

Many vulnerable Americans, the pollsters learned, also don’t know how to use the Internet effectively to find the health care information they need. “They’re not terribly sophisticated when they search,” said Helen Leis, partner, Health & Life Sciences at Oliver Wyman. “While other consumers might Google the name of a procedure, or a doctor quality review by ZIP code, these consumers Google something like: ‘I need a doctor.’” That kind of scattershot approach, says Leis, “gives them a lot of noise.”

The executives surveyed weren’t terribly surprised to learn that health information isn’t getting to consumers adequately to help them make informed decisions, said Leis. But they were stymied about how to fix the problems.

“They know the information needs to be more tailored and personalized, but they’re not sure how to do that or what it means,” said Leis.

Flip the Health Information System

Some solutions aren’t all that difficult, though.


For instance, says Duke, “we need to move away from a system that requires people to seek out health cost and quality information, because people are not very good at that.” Instead, he says, when health insurers know that consumers plan to have surgery, “send a list of prices and quality comparisons of all the facilities in their area to them.” That, he adds, “would make it very easy to make educated, informed decisions.”

Paging Aretha Franklin

Another pretty simple solution: Take the Aretha Franklin approach. R-E-S-P-E-C-T. “More eye contact with patients, more listening to patients and not being dismissing of their concerns or questions,” said Leis. According to AARP, studies have found that doctors let patients speak for only 23 seconds before cutting them off.

Granted, talking with patients more might make appointments slightly longer, but the effect on patients’ health could be dramatic.

What Spanish-Speaking Patients Need

Another possible solution for doctors and hospital staffs: Ask Spanish-speaking patients if they’d like to receive their health information printed in Spanish.

Many Spanish-speaking immigrants surveyed were reluctant to request the information be translated to their native language. “They were afraid they might be reported to Immigration when they were admitted to the hospital or they’d be treated poorly,” said Leis. “Most of the health providers do offer the information in Spanish, but they don’t necessarily promote that.”

The Doctors' Photo Problem

Oh, and the pollsters say there’s one other way doctors could make themselves appear friendlier and it surprised the executives surveyed (don’t laugh when you read it): Smile in their photographs.

Some vulnerable consumers “assign a quality rating in their minds based on the photographs,” said Leis. “How they look in the photos signals whether they think the doctor will treat them with respect.”

The health execs told the pollsters they want their doctors to look “serious and respected.” But, one health plan executive said, maybe their doctors should have two sets of photographs — “one for their professional organizations and one to be more welcoming to patients.”

Photograph of Richard Eisenberg
Richard Eisenberg is the former Senior Web Editor of the Money & Security and Work & Purpose channels of Next Avenue and former Managing Editor for the site. He is the author of "How to Avoid a Mid-Life Financial Crisis" and has been a personal finance editor at Money, Yahoo, Good Housekeeping, and CBS MoneyWatch. Read More
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