Consumer decision making in healthcare: The role of information transparency
Authors’ Note: These survey results reflect pre-COVID-19 answers and sentiments. For the latest in consumer feedback, please visit https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights.
As consumers experience more information transparency across various industries, many expect more accessible, user-friendly data around healthcare. The result has left some entities struggling to keep up with rising expectations, while others have adjusted by lowering prices, improving quality of services, and focusing on patient experiences.
Still, despite these consumer preferences and push, in our 2019 Consumer Health Insights Survey, only a fraction of respondents said they have been able to retrieve the information they sought when making healthcare decisions, contributing to low satisfaction.1 Our analysis shows that when respondents can access relevant information when making a healthcare decision, they will choose an option that best meets their needs. They often look for lower costs, even if it means making other trade-offs (for example, a more convenient location).2
More than 60 percent of patients report they want more information when deciding where to get care.3 In a world of limited information, some patients chose to look for more information, while nearly 49 percent of respondents stated that they instead chose to follow the recommendation for care from their doctor, clinician, or health insurer.
In our analysis, about 90 percent of respondents chose the lower-cost, in-network options that were of average quality over the higher-quality,4 higher-cost options. Our research suggests that providing consumers with better and more accessible information could have a profound impact on how decisions are made (Exhibit 1).
What does care look like in a world where consumers have more transparency of information?
Consumers have driven certain healthcare businesses to adapt and meet their expectations. These adaptations include:
- Lowered price: The cost of elective surgeries, such as LASIK surgery, breast augmentation, and eyelid lifts, has decreased 10 to 15 percent cumulatively over the last decade, enabled by technology advances that now allow these entire procedures to take around 10 minutes.5 By comparison, the price of nonelective surgeries, like childbirth delivery, has increased by up to four times over the same time period.6
- Improved quality of services: As the price of some elective consumer services declined, the quality of those same services has improved. For example, when LASIK first debuted in the 1990s, 60 percent of patients had 20/20 range of vision after surgery. Today, those numbers have improved dramatically, with more than 90 percent achieving perfect vision.7
- Improved experience: From contact lenses on-demand to at-home kits for retainers to customized healthcare entities, healthcare leaders and start-ups are investing rapidly in improving experiences for consumers. Customers are able to receive more personalized, seamless, and digitally enabled healthcare experiences, such personalized live video doctor visits.
What increasing information transparency and new business models mean for traditional healthcare services
While rising customer expectations are driving new business models, increased choice pressure is also affecting existing healthcare systems. Increased price transparency is driving more pricing information, and therefore more “shoppable” healthcare services. Certain services with relatively straightforward pricing structures, such as imaging, can now be viewed in easy-to-use, Kayak-like search engines in certain areas. For example, Colorado’s Center for Improving Value in Health Care’s online tool allows patients to locate facilities with the lowest cost, nearest location, and best patient experience; this information empowers patients to potentially significantly lower the cost of their healthcare services.8 Previous research has indicated the use of price transparency information was associated with lower total claims for routine medical services, with the largest difference for advanced imaging services.9
Start-ups are offering consumers more options, such as healthcare financial wellness platforms that provide the information they need to make high-value healthcare decisions or tools that make shopping for government-funded healthcare more transparent. Other companies have focused on digital marketplaces for patients to purchase prescriptions with full-price transparency. While many providers have been either hesitant or challenged in offering price transparency estimates, some have worked to provide greater transparency.
For example, UCHealth in Colorado, Mayo Clinic in Minnesota, and University of Utah Health have been commended for their efforts in price transparency,10 enabling consumers to receive an estimate for services. While the consumer is warned that it is impossible to know the exact cost, this high-level estimate gives patients the ability to make more informed decisions around their care. Additionally, many providers (such as retail clinics and urgent care centers) of basic health services (for example, lab tests, primary care, ancillary) offer standard pricing, which removes any need for consumer uncertainty.
How is the lack of information transparency today driving consumer behavior?
Respondents said they desire personalized, tailored information to make the right decisions about their healthcare—particularly in relationship to cost. Some gaps currently exist between the healthcare information that they want, what is available, and where it can be found. Moreover, respondents said they find the tools meant to help often do not give them the information they need.11
Information for deciding where to get care
Most respondents don’t have the information they want when deciding where to get care12 That lack of information also is reflected in low consumer satisfaction scores. Among 15 journeys respondents rated, commercially insured respondents reported the lowest satisfaction scores for “ability to find out if there are lower-cost options for treatment” and “ability to figure out what their cost for a service would be” (scoring 7.2 out of 10.0). In contrast, “how easy it was to fill a prescription” had the highest satisfaction score (8.5) (Exhibit 2).
When important information wasn’t available to them, many respondents relied upon recommendations from their physicians or insurance companies when deciding where to get care. Among respondents who didn’t have the desired information when deciding where to get care,13 35 percent “followed the recommendation for care from their physicians and didn’t look for the information.” Fifteen percent said they “followed the recommendation from their health insurer and didn’t look for the information.” Fifteen percent said they “didn’t know where to get the information.”
“I would like to clearly understand what is covered and what isn’t. It’s so hard to find that information. Even when you call, the people on the line, they can’t give a clear answer.”
—Female, 33, group
While most insured respondents say that they understand their deductibles, opportunity remains to further expand information about this category. Many insured respondents didn’t know what their deductibles were.14 Thirty-four percent didn’t know their deductible for out-of-network medical coverage, 24 percent didn’t know their deductible for prescription drugs, and 16 percent didn’t know their deductible for in-network medical coverage. Furthermore, as an example for choosing the most cost-efficient site of care, only 45 percent of respondents said they understood“cost differences for inpatient (hospital) vs outpatient (non-hospital) settings for a procedure” such as a colonoscopy.15
“I asked for the information, but providers refuse to disclose … the cost.”
—Female, 42, uninsured
Information for quality of care
Respondents were asked to select the important factors that would give them confidence that they would receive high-quality care (Exhibit 3).16 While more than half cited their own experiences or said proof or evidence of good health outcomes, 38 percent said their confidence was based on whether “a facility has a good reputation for quality/scored well by publications.” Only 31 percent said they had confidence “based on a recommendation from another medical professional/clinician.”
Respondents were asked to report where they learned about the quality of a clinician or facility they wanted to visit or have visited.17 Thirty-seven percent said they searched online/used an app, while 31 percent visited the hospital or physician’s website. Twenty percent said they used their health insurer’s website or app. Thirty-four percent asked their primary doctor for advice, while 28 percent asked friends or family.
Respondents were asked about their preferred sources of support for healthcare decisions (Exhibit 4).18 Respondents generally said they preferred their primary care providers (PCPs) to support them in making clinical treatment decisions, while preferring their health insurance companies to support them in understanding costs and benefits. They relied on their own web research for selecting a PCP and a pharmacy, and for obtaining information about provider quality performance.
How could decisions (and cost) be supported by greater information transparency?
When consumers have access to information that is personalized to their situation, they are likely to make different decisions, often prioritizing factors important to them, such as cost. The survey attempted to understand how consumers might use transparent information to make decisions through a simulated experience. We identified several trends through this simulation:
- Across different scenarios, respondents often chose lower-cost options that are of average quality rather than higher-cost, higher-quality options. As we increased out-of-pocket costs, even fewer chose higher-cost, higher-quality options.
- Most respondents were willing to change their preferred site of care when they learned that someone they knew experienced a poor administrative experience at that site.
- Proximity appears to be more of a “nice-to-have” option. Most respondents chose lower-cost or high-quality options over options that were higher-cost and more convenient.
- Past consumer experiences matter in decision making. We found respondents who have experienced an inpatient stay in the past or face chronic conditions are more willing to choose higher-quality options that are more expensive.
To ascertain consumer choices in a real-world situation, we created three different health scenarios.
We asked respondents to imagine that they recently moved and were looking to find a new PCP for their annual physicals. Respondents had to pick a PCP that best fit their needs. We provided them with eight options that had varying location information, wait times, and out-of-pocket costs.19
- Respondents preferred going farther away if they could get an appointment more quickly (43 percent chose the farthest option where they could be seen within 24 hours; 14 percent chose the closet location but where their wait would have been between four and six days).
- Few respondents (17 percent) were willing to pay a higher cost for a more conveniently located facility.
- Respondents were equally split between preferring to book their appointment online or call. More than half of Gen Z and millennial respondents preferred booking online, while more than two-thirds of baby boomers and those older preferred booking over the phone. Gen X respondents were equally split.20
Respondents were given a hypothetical review of their doctor’s office that described a poor administrative experience around incorrect billing. Forty-five percent of respondents looked for a different doctor’s office after reading about a poor administrative experience (Exhibit 5).21
We next asked respondents to imagine that they had been visiting a specialist and were referred for an outpatient procedure. We informed them that their health insurance plan has a $5,000 deductible. We showed them five options with varying locations, quality, appointment wait times, and costs.22
- Thirty-two percent of respondents were willing to drive 30 minutes farther if it meant a cost savings of $750. This result skewed more heavily with younger generations.
- More than a third were more motivated by quality, with a fourth choosing a higher-quality option that had a week-longer wait than others. More than a third of respondents over age 65 chose this high-quality, less convenient option.
- Few respondents (13 percent) chose the most convenient, lowest-quality option. Gen X had the highest share, at 16 percent, of those choosing the convenient option.23
In the simulation, we told respondents that the original cost was wrong: it would now cost $100 to $750 more for the option they chose. Fewer respondents said they would look for an alternative option (22 percent) when their original choice was $100 more, but nearly half (48 percent) would do so if the cost was $750 more.24 Respondents who said they would stick with their original choice tended to be younger, wealthier, and individually insured.25
In the third scenario, respondents were asked to imagine that their specialist and physical therapist recommended spinal surgery to improve their lower back pain. Respondents were asked to pick a facility they would want to attend to receive surgery.
We presented respondents with four options: two that were in-network, and two that were out-of-network. The in-network options were of average or slightly above-average quality, while the out-of-network options were high quality. About 90 percent of respondents chose the lower-cost, in-network options that were average quality over the higher-quality, higher-cost options (Exhibit 6).26
We informed the respondents of a poor administrative experience in which the specialist did not communicate well with the respondents’ PCP. We found a similar number of respondents were driven to switch locations based on learning about a poor experience. Of the 45 percent of respondents who originally picked Hospital 1, 52 percent of respondents switched hospitals (Exhibit 7).27
The healthcare industry is becoming more transparent as stakeholders in the healthcare ecosystem are not only expecting but also often demanding access to information. Providing consumers greater access to transparent information that they can understand has the potential to significantly improve their ability to engage in choosing where to receive care, including making trade-offs that are important to them, while improving their experience.
When armed with transparent information, consumers are likely to make different decisions. These decisions include choosing a different provider, often considering reputation, quality, and costs. Convenience is less of a priority when tackling health concerns: younger generations tend to be more willing to drive longer distances to seek a lower-cost solution, while those over age 65 prefer high-quality options, even if they are less convenient. With greater ability to choose, “shoppability,” and more options for healthcare services, nearly all patients may in fact move to the lower-cost, in-network options that are of average quality rather than choose the higher-quality, higher-cost options.28 As the conscientious consumer continues to gather more information via existing and new channels (such as online portals and social media), providers face a significant risk of losing patients who are equipped with, for example, information about poor administrative experiences.
On the flip side, healthcare companies that lead the way in transparency may have the opportunity to build relationships with consumers to help them make their health decisions more effectively and to shape what and how information is shared at the industry level. These companies that can provide greater value to consumers will benefit from increased customer satisfaction. For those healthcare companies seeking to lower the total cost of healthcare, engaging consumers has been an underutilized means of improving medical cost trend. As technology, data, and consumer engagement increase, so too will the importance of information transparency in improving the healthcare ecosystem.
This article was edited by Elizabeth Newman, an executive editor in the Chicago office.
- Forty-five percent of respondents reported dissatisfaction with their ability to figure out the cost of a service, and 45 percent of respondents said they were not satisfied with their ability to find out if there are lower-cost options for treatments (ranked 1–7 on a 10-point scale). This lack of information transparency corresponded to negative effects on a consumer’s overall experience. When respondents were asked to rank their satisfaction, they repeatedly ranked information transparency areas, such as understanding the cost of care, understanding their bill, and finding the right provider, as points of low satisfaction that negatively affected their healthcare experience. 2019 Consumer Health Insights research (CHI), QIJ3. How would you rate your satisfaction in each of the following areas? Scale 1 (highly dissatisfied) to 10 (highly satisfied).
- 2019 CHI, FJB2. Imagine that you went to your health insurer’s website where they provide the following information. Based on this information, which facility best meets your needs?
- 2019 CHI, QDJ1. How important is the following information when you’re deciding where to get care?
- Respondents defined “quality” as both quality of experience and quality of health outcomes: 53 percent of respondents define the quality of their healthcare by their personal experience, and 51 percent define quality by the type of health outcomes that they see after receiving care.
- All About Vision, allaboutvision.com; “National Health Expenditure Accounts,” Centers for Medicare & Medicaid Services, 2018, cms.gov; “Plastic Surgery Statistics,” American Society of Plastic Surgeons, 2005–18, plasticsurgery.org; The LASIK Vision Institute, lasik.com.
- Stranges E, Wier LM, and Elixhauser A, Complicating Conditions of Vaginal Deliveries and Cesarean Sections, 2009, HCUP Statistical Brief #131, Agency for Healthcare Research and Quality, last modified May 13, 2016, hcup-us.ahrq.gov.
- Sandoval HP et al., “Modern laser in situ keratomileusis outcomes,” Journal of Cataract & Refractive Surgery, 2016, Volume 42, Issue 8, pp. 1224–34.
- “Consumers can now shop for healthcare imaging services in Colorado with CIVHC’s new tool,” Network for Regional Healthcare Improvement, July 16, 2018, nrhi.org.
- Whaley C et al., “Association between availability of health service prices and payments for these services,” JAMA, 2014, Volume 312, Issue 16, pp. 1670–6, jamanetwork.com.
- Porter S, “Verma commends 3 health systems for their price transparency,” Healthleaders, January 10, 2019, healthleadersmedia.com.
- 2019 CHI, DJ2. Why don’t you have the information you’d like when you’re deciding where to get care?
- 2019 CHI, IJ3. How would you rate your satisfaction in each of the following areas? Scale 1 (highly dissatisfied) to 10 (highly satisfied).
- 2019 CHI, DJ2. Why don’t you have the information you’d like when you’re deciding where to get care?
- 2019 CHI, C5. What is your deductible for your health coverage?
- 2019 CHI, DJ6. How well do you understand the following for you?
- 2019 CHI, DJ3. Please rank up to the three most important factors that you think of that would give you confidence you would receive good quality care.
- 2019 CHI, DJ4. In those situations, how did you learn about the quality of the clinician or facility that you wanted to visit or visited?
- 2018 CHI, E1A–E23A. Who would you want to support you in choosing the (right health insurance plan, primary care provider, etc.) for yourself and/or your family? Why would you most prefer the option you chose?
- 2019 CHI, FJ2. Imagine that you went to your health insurer’s website where they provide the following information. Based on this information, which primary care provider best meets your needs?
- 2019 CHI, FJ2. Imagine that you went to your health insurer’s website where they provide the following information. Based on this information, which primary care provider best meets your needs? S1. How old are you today?
- 2019 CHI, FJ3. Before your first appointment, imagine you read a patient review of the doctor’s office that says, “The doctor is good but the staff needs help! I’ve received incorrect bills multiple times and the staff is rude and unhelpful when I call to talk with them.” What would you do?
- 2019 CHI, FJ2B. Imagine that you went to your health insurer’s website where they provide the following information. Additionally, your health insurance plan has a $5,000 deductible so you will have to pay for all costs up to $5,000. Based on this information, which facility best meets your needs?
- 2019 CHI, FJ2B. Based on this information, which facility best meets your needs? S1. How old are you today?
- 2019 CHI, FJ3B. When you call to schedule your appointment, the facility lets you know the price on your insurance company’s website was wrong and the procedure will cost [X] more. What would you do?
- 2019 CHI, FJ3B. What would you do? S1. How old are you today? S11. For 2018, what was the total annual income for your household? S12. By age, income, and insurance status. Which of the following best describes your current healthcare insurance coverage?
- 2019 CHI FJ2C. Imagine that you went to your health insurer’s website and you see you have $2,000 left on your deductible before your health insurance will pay everything for in-network locations. For hospitals that are out of network, they’ll cover 80% of the cost. Based on this information, which hospital best meets your needs?
- 2019 CHI, FJ2. Based on this information, which hospital best meets your needs? FJ3C. Before your appointment, you find out that a close friend had a similar back surgery at the same location several years ago. Your friend mentions it was very difficult to schedule your follow-up appointments and the facility didn’t communicate very well with her primary care provider. What would you do?
- 28 2019 CHI, FJ2C. Based on this information, which hospital best meets your needs?