Editor`s Opinion: Healthcare as Hobson`s Choice

   Many years ago, when the phrases market-based reform and consumer-driven healthcare first surfaced, I couldn’t help but envision people flipping frantically through the Yellow Pages™ of healthcare while being wheeled into an ambulance. I just couldn't see how patients were going to "drive healthcare," and I still can't.

How can consumers shop around and compare the quality of the care they receive? What do you look for when flipping through the Yellow Pages of healthcare? Friendly clinicians? A nice receptionist? New carpets in the waiting room? Have you ever wondered why hospital food is such a favorite topic of discussion among patients? It’s one of the few things they can judge!

   We like choices. That's why the phrase, or perhaps more accurately, the slogan, consumer-driven healthcare, caught on. Choices provide a sense of control and freedom. But how can consumers choose and drive healthcare when they have no idea how to judge the quality of their care or the accuracy of a diagnosis or test result? How many choices does one have when there is one hospital in town and the next one is 500 miles away? How can patients reform the market when the number of insurance companies that will accept them totals one, or worse, none? How can providers reform the market and choose when their patient's carrier reduces payments? What are your options when you have but one liability insurance provider in a geographical area because the "market has contracted?" How free-to-choose are you when, according to The Wall Street Journal, health insurance companies are surreptitiously hiking the rates of the chronically ill?

   In the real world, choices in healthcare are truly Hobson's choices. In the 17^th and 18^th centuries, Hobson was in the business of renting horses to Cambridge students. Although he may have had 40 horses available at any given time, when a student wanted to rent one, there were two choices: take the one nearest the stable door or take none at all. If you really needed a horse, you just had to hope for the best. Patients do the same thing every day.

   Have you ever heard someone tell you that his/her procedure would be performed by the second-best surgeon because the top-doc was busy or that he/she was going to the second-best hospital? Of course not. In the real world, there is no choice, only trust - trust that the care provided will be optimal, that the diagnosis is correct, and that the laboratory results are accurate. In the real world, most patients cannot comparison shop for the best chance of a good outcome. There are no Yellow Pages of healthcare or Michelin guides to practitioners and hospitals. In a true market-based system, there could be... and would be. In this market-based system of consumer-driven care, neither the patients nor the providers are in the driver’s seat. They have Hobson’s choices and hope for the best. Perhaps it is time to select another livery.