Odd California Survey
My last post included a reference from the Health Affairs blog, which cited a survey of California health care consumers. The quote that caught my eye was –
… [A] recent Lake Research Partners survey found that only 38 percent of California participants in HDHPs reported that they have ever searched for information about the cost of a test or treatment (compared to an even more disappointing 26 percent of consumers in other types of plans).
That was an interesting observation so I followed the link to get more information about this survey.
What I found is perplexing. This is a very large (1,528 respondents) online survey by Lake Research Partners, using a database from Knowledge Networks. I’m a little wary of online surveys to begin with. Clearly the people who are comfortable completing a survey online are different than the people who are not. I suppose it is possible to adjust for these differences, but there would have to be a parallel survey of personal interviews to know what adjustments to make. This was not done in this case.
The other big weakness of this presentation is that, although the researchers present 683 pages of data tables, they do not provide any information about the interview process, such as whether they define the terminology or just hit people cold with questions about deductibles and co-pays. This omission is important because they get some very odd responses from the respondents, and one has to wonder how much information was provided to get these answers.
The most blatant examples are the questions on insurance deductibles. The researchers find that 39% of respondents say they have no deductible and 50% say they do. Of that half with deductibles, 45% said they did not know or refused to say how much it is. Of the rest, 11% said it was under $100, 14% said $100 to $499, and 30% said $500 or more.
Okay, it seems implausible that nearly half of the people with a deductible would not know how much it is, but it is possible. People who don’t consume many services may not be paying attention to when the coverage kicks in.
But then the researchers report that 23% of the people on MediCal, and 43% of the people on Medicare say they have a deductible. Unless California’s program is radically different than Medicaid programs in other states, none of the people on MediCal should have a deductible. Plus, outside of some Medicare Advantage HMOs, everyone on Medicare does have a deductible — actually two: One for Part A and another for Part B.
These responses don’t match any reality that I am aware of, and one has to wonder if the respondents understood what a deductible is. That is why the wording of the question is important. Did they define the word “deductible,” or did they just assume people know what it means? Shouldn’t there be some explanation for these peculiar results?
Now many people might not know what a deductible is, but surely they know what a premium is, but 32% of respondents didn’t know or refused to say whether they have to pay a premium — 37% of those with family coverage.
Given that so many people don’t know about their deductible or their premium, perhaps it is not surprising that 48% of respondents thought their insurance costs “stayed about the same” from the previous year. But how reliable is that opinion?
But the problems with this survey are even greater when it comes to the questions about receiving health care services. One question is “Where do you usually go when you need routine medical care, like a physical or a checkup?” This assumes: 1. That everybody actually uses medical services in the course of a year, and 2. That everybody would want or need a physical or a checkup during the course of a year. I don’t know about you, but in the course of my life I have often gone many years without using such a service. I expect most men are like that. But the researchers seem concerned that “About one in ten (11%) adults does not have a place they usually go to receive care.” I’m surprised the number is not larger.
They go on to ask about how easy is it to find a doctor who accepts your health insurance, and are concerned that “those who report being in fair or poor health have, on average, twice as much difficulty finding providers who accept their insurance as those in excellent or very good health.” They break this down into primary care doctors, specialists, and mental health providers.
Now, maybe it is just me, but why would someone in “excellent to very good health” even be trying to find a specialist? Maybe they don’t have trouble finding one, because they don’t need to find one.
Okay, I won’t belabor this any further, but this survey seems like yet another example of health care research that is more interested in inventing problems than in actually measuring reality. We have too many researchers with nothing to do and too much money to spend on useless projects.
Online survey + Bad information = Problems
Really? I hope they just refused because we’ve got a bigger problem on our hands if they flat out don’t even know how much they’re paying when they receive medical care.
One of the biggest problems in healthcare is that it seems like very few people truly know how the system works and how they fit into it.
Some of the confusion can possibly be explained by employer-controlled HRA plans. They, technically, are HDHPs but don’t really put consumers in control like HSAs do.
The only people your really going to poll in an online survey are the kids who can use computers, not the parents who give them health insurance.
Of course this survey is bogus, as is the majority of other surveys, regardless whether done by telephone or on line. It is very much like the political polls. How can one reduce a complicated subject to a simple question and get anything in return but a simple minded answer?
Even if surveys were not normally agenda driven, they really don’t expose much more than the naivete of the folks being questioned.
@ Paul,
Your comment is right on the spot! I agree with you 100%. Online surveys are well known for their unaccuracy and lack of reliability. Most people that take these surveys belong to younger generations, and these people (for the most part) don’t even take the generous amount of time needed to make their responses as accurate as possible…so I wouldn’t really think anything of the results obtained here, whether good or bad.
Interesting post and analysis.
“those who report being in fair or poor health have, on average, twice as much difficulty finding providers who accept their insurance as those in excellent or very good health.”
—Im disturbed to read this.
frank timmins: I’m pretty sure that surveys are an accepted part of scientific study in social science fields. Properly constructed/conducted surveys collect facts that can then be used to draw conclusions and answer questions.
But I agree that this survey probably isn’t valid.
Thanks for all the comments. The most disturbing thing is that this is the kind of “research” policy-makers base their decisions on. And then we wonder why nothing they do ever works.
I’ve tried to do consumer research that required the consumer to self identify based on coverage type, deductible, premium, etc. it NEVER works. People aren’t stupid, they just don’t need to know what all these terms mean or keep the numbers at hand. So I would attach zero value to these results, even though they happen to support the premise that HDHPs result in better consumers.
A lot of people with high-deductible plans HSA plans are not going to search for prices of routine office visits. That’s fine – nobody wants to spend time searching and then change doctors to save $10 on an office visit. Most people are healthy, so they probably haven’t had the opportunity where they need to inquire about the price of a service. But when their doctor orders an MRI or something major, then they begin to ask questions. This often occurs after they discover the “convenient” hospital outpatient diagnostic center nearby wants thousands of dollars for a diagnostic test. Hopefully they find out while they still have options.
A friend of mine was quoted a cost of nearly $3,000 for a CT scan. After she freaked out at the thought of being asked to pay $3,000, I asked why on Earth she was calling a hospital outpatient clinic for something that could be obtained elsewhere for a fraction of the cost. She had no idea prices for medical services varied from one location to another. It took me only a few minutes to find a radiology clinic that would do the service for $400 — right next door to her doctor. It only takes one instance like this to change the way people think about health care. But this is the type of quiet revolution that probably doesn’t show up on an online survey.
Jon, I would ascribe those same qualities to those that administrate our SS programs too.