Patient Power and the Internet
The growth of the Internet and the vast amount of information it makes available are dramatically changing health care and medicine. As many as 100 million people in the United States now have access to the Internet, and that number is expected to grow by 50 percent over the next few years. Health information is some of the most popular content on the Internet.
- An estimated 15,000 to 20,000 web sites provide health information.
- According to a recent Harris Poll, 70 million Americans went online between June 1998 and June 1999 to search for information about health.
The new access is helping to demolish a key argument of those who oppose patient power in general and Medical Savings Accounts in particular: that people do not have the necessary expertise or desire to manage their own health care dollars.
What type of information are people seeking?
In a survey by Health on the Net Foundation, 90 percent of health information seekers said they found the information they were seeking.
- More than 70 percent searched the medical literature.
- More than half sought descriptions of diseases or information about their treatment.
- More than 80 percent searched for information on drugs, including their side effects, interactions and generic availability.
A Harris Poll found that the most-visited health-related web sites were those of medical societies (40 percent), patient advocacy or support groups (32 percent), pharmaceutical companies (20 percent), hospitals (16 percent) and other sites including commercial sites (26 percent).
Who is using the Internet?
Part of the growing demand for health information on the Internet is driven by an aging population. As the figure shows, more than half of those seeking health care information are between the ages of 40 and 60, whereas only about one-third are between the ages of 20 and 40. Women are almost twice as likely to search for health information as men, although this ratio lessens with age. Online support groups are especially popular among women. By some estimates, women comprise 75 percent of visitors to those groups.
Why are people using the Internet?
Consumers have demonstrated the desire to take more control of their lives, including their health care. And the Internet allows them to do so. Medical information that once was available only at large libraries or medical schools can now be retrieved free of charge from a desktop or laptop computer. Medical science is advancing so rapidly that few physicians can keep abreast of every change. So it makes sense for patients to try to supplement the doctor's knowledge with whatever additional information they can glean.
For example, people with rare or unusual diseases or medical conditions now look for innovative or experimental approaches being tried in other parts of the country or abroad. Online support groups allow diverse people to connect and share information with others suffering from the same medical conditions. Furthermore, information about the thousands of clinical studies currently being conducted enables patients to post online inquires about participation.
Researchers have found that people also are turning to the Internet because managed care health plans offer doctors perverse incentives to cut costs. Patients want to confirm that they are receiving the best treatment available for their conditions.
Who's in charge?
In the traditional doctor-patient relationship, patients relied on a physician for virtually all their information. Many patients no longer are satisfied with that arrangement. When Sapient Health Network surveyed its online support groups, people with chronic or serious illnesses rated their groups as a more useful resource than their specialist or primary care doctors for 10 of 12 dimensions of care. Electronic support groups, they said, not only were more cost-effective but also provided more in-depth information on the illness and more help in locating other medical resources.
Dr. Nancy Dickey, president of the American Medical Association, told the Washington Post that a large number of doctors now routinely advise patients to use the Internet to obtain second opinions.
MSAs in the Information Age.
Medical Savings Accounts, designed to give patients more control over their health care spending, can work especially well for consumers who use the Internet. An Information Age MSA might be aligned with a health insurance company - possibly an HMO. The subscribers could go online to check insurance benefits or see whether they have met a required deductible. They might schedule appointments online, or e-mail questions to their physicians - who could respond with treatment options. They could look on the Internet for competing providers of diagnostic tests or lab work, then select the ones with the lowest price and highest quality. Even those subscribers who chose top-of-the-line health care would have the security of knowing they had compared providers and likely were getting a better price for treatment than they otherwise would have. They might even obtain diagnoses and treatment plans online.
Concerns about Internet information.
Some health care professionals worry about the quality of medical information on the Internet. Certainly one can find charlatans and remedies backed by little or no credible research. But one also can find bad information in print, and some web sites offer help in weeding out the good from the bad. For example, the web site Drkoop.com, which bills itself as "Your Trusted Health Network," has a section that rates other health sites with one to five stars. Dr. C. Everett Koop, a former U.S. surgeon general, said he expects that the fly-by-night operators won't last long on the web. Some in the industry are working on a code of ethics to ensure the quality of information.
More leverage for patients.
MSAs and the Internet can help remove most of the one-sidedness that now exists in health care. Whereas hospitals and clinics traditionally refused to post prices and negotiate fees with patients, when prices of various services are posted on the Internet, price competition will become more common. Physicians once hesitant to discuss prices for treatment options will lose customers if they don't. Diagnostic labs or x-ray facilities will compete for customers. Disease-specific organizations, connected via the Internet, will be able to treat patients across the country. Medical records will be the property of the individual, stored electronically by an independent provider and accessible from anywhere with the patient's permission.
People want more control of decisions about their health care. This is especially true of baby boomers, whom the research firm J. D. Power and Associates have characterized as "the epitome of the empowered consumer: they are accessing disease-specific treatment and medication information to a higher degree than other groups." Many managed care organizations are attempting to use the Internet to transform their customers from adversaries into partners. With patients having easy access to information on new treatments and medications, managed care needs for them to have a financial incentive to consume medical goods wisely. "e-MSAs" can provide that incentive.
Devon Herrick is research manager for the National Center for Policy Analysis.