Unbiased Analysis of Today's Healthcare Issues

Rating the “demi-gods in white”

Written By: Jason Shafrin - Nov• 19•07

GigaOM reports on some new Health 2.0 developments in Germany in its article “Health 2.0 Gaining Traction in Germany.”  Websites such as Helpster and Imedo are among a number of website which are now rating German physicians.  In order to take into account established medical institutions, Imedo is including the physician certification status as part of its rating.  This certification status is decided by the German Kassenärztliche Vereinigung, “a public organization in charge of distributing the lion’s share of physicians’ income.”

Will German physicians even engage in price competition for patients?  Two German websites believe so:

In the transactional domain, 2te-Zahnarztmeinung and Arzt-Preisvergleich have gained significant traction by running reverse auctions — primarily for dentists’ treatments — which allow for a high degree of comparability. Navigating closely on the edge of what German law allows, a potential patient does not have to automatically contract with the cheapest offering. Instead, she can compare all anonymously quoted prices and take into account the ratings given by patients who have undergone a similar treatment. The physician she chooses then awards 15 to 20 percent of his fee back to the platform.

Is this the wave of the future?  The Healthcare Economist says yes and no.

Yes because for medical procedures which are 1) fairly routine, 2) of relatively low risk and 3) where the patient has a high quality of information regarding the cost and benefits of the procedure, the internet can provide an important means of disseminating information and driving down price.  Dentist visits are predictable and quality is relatively easy to measure.  Thus using these websites will be a boon to consumers.

No because for more complicated procedures these website’s information will likely not be helpful.  Using outcome measures for complicated procedures must make risk adjustments to take into account patient case mix.  Process measures may be to simple to take into account factors such as disease interactions.  And structural measures (e.g.: nurse-patient ratio, the use of electronic medical records) may only be peripherally related to the quality of care.  I doubt that cardiothorasic surgeons will start bidding for patients any time in the near future.  Patients, whose cost for these expensive procedures will generally be covered by insurance, will choose a doctor likely based on their primary care doc’s referral or the opinions of their peers.

Thus, the Health 2.0 movement is likely to be a significant development for the low-cost, predictable sector of medical care.  Specialist and hospital care is much more difficult to measure and price and I believe will likely be hardly affected by these new developments.

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  1. We always try to figure out what will happen with procedurally-based specialties, but the choice of primary care or a cognitive specialist interests me more. I am also uncertain how rating will help when the decision of whether or not to purchase is highly technical or when the provider is obliged to refuse “to sell” in the patient’s interests. Of course there is a healthy dose of somewhat noxious medical paternalism in making this medical judgment, one which runs contrary the consumerist notion that leads to ratings in the first place. In the aggregate, do you think that it may have a greater impact on the health care system to figure out how to improve the quality of primary care?

    But who are we characterizing as demi-gods? I suspect you are referring to doctors instead of referring to hospitals or insurance companies that really control much of health care, but. As a physician, I could humbly accept such an onerous responsibility if that’s what you mean, but of course, a deconstructionist would really make hay with what you are implying.

  2. […] GigaOM oder Healthcare Economist […]

  3. […] Shafrin on the Health Care Economist blog analyzed the reasonableness of expecting physicians to compete on the price of procedures. He noted that […]