Unlike Elaine of Seinfeld fame who failed to change doctors because her last one wrote in her medical record that she was difficult, today’s generation of Elaines have more access and control over their records, and more say in where to go. They tend to rely more on what they know and hear and see everyday, sometimes for good and sometimes not. Take the increasing prevalence of urgent care and on-site wellness clinics in retail locations like Walmart and Walgreens and CVS – in my town alone, there are 3 of these so-called clinics in one strip mall and nearly every other day there’s an ambulance waiting outside, presumably to transport a patient to the hospital, likely due to a heart or lung issue. Many insurance plan medical directors argue that urgent care has value, particularly in rural areas, but believe that at least one-third who use it are ‘worried well’ and their ‘problems would self resolve’ while others with serious conditions tend to use it because they are worried about the ‘bill for using the ER.’ Even my own dad needed urgent care after falling last weekend and landing on a rock, his shin requiring 6 big stiches, but 2 of the local urgent care centers were closed, and the ER became a viable option.
In our study of 345 adults released today, 80% of the males said they go to urgent care ‘because it’s easier’ while 87% of the females prefer to see their doctor, not urgent care, and rely on the doctor’s recommendations if they need a specialist. Neither males nor females rely on insurance information for recommendations to any great degree. In fact getting a friend’s recommendation is most important for women when selecting a primary care doctor, and OBGYNs are often the best source of information for women when selecting specialists.
Interestingly, 83% in the study have had children and new moms said they got their ‘first lactation consult’ in the hospital and either ‘used that same specialist’ or got a ‘recommendation on who to use from the hospital discharge nurse’, even their child’s pediatrician. Less than one fifth in study of 345 adults said they have checked with their insurance when selecting a specialist, but in nearly all cases this was done to ‘validate’ who was already recommended to them by a professional.
The results from the study on how adults decide who to use for healthcare is interesting given the recent trend in how insurers are paying OBGYN practices for managing maternity costs and outcomes. Increasingly, insurers like BCBS and United Healthcare are paying physicians for managing moms over a year-long episode from pregnancy through a 3-month post-partem period. All costs – screenings, office visits, ER visits, labor, delivery, C-sections, and any follow up care, such as lactation support, would be included, and OBGYNs would be incented essentially to manage mom closely – ensuring the ER is avoided if possible and that post-partem depression and other costs are addressed early enough. That so few in the study (just 3%) say they have relied on the insurance company’s network directory for selecting lactation specialists may be relevant as more OBGYNs enter these arrangements with insurers. Will the arrangements encourage use of certain specialists over others and will use of specialists that aren’t in the health insurer’s network directory create issues for risk-taking doctors?
94% in the study have at least a bachelor’s degree and a higher-than-typical ‘healthcare acumen’; the study authors believe that the results on use of network directories to make decisions might be somewhat less for those without college degrees.
To read the study findings, click here