Sunday, October 17, 2010

Mind the gap: information asymmetry in care

Recently, the Archives of Internal Medicine published a study demonstrating the persistence of communications discrepancies between physicians and hospitalized patients. For anyone who has ever been hospitalized, or known someone who has, this evidence is not really that surprising.

One good example- only 17% of inpatients can correctly name their main physician. That actually does not surprise me. Being hospitalized is usually a high-anxiety kind of situation. Remembering your doctor's name is probably not a priority, as much as remembering to take in all of your fluids might be. With that in mind, it is interesting to note that only 57% of patients were actually aware of their diagnosis, while 73% of the respective doctors studies believed their patients were in the know of their medical condition. The same kind of aforementioned anxiety and fear may have played a role in this discrepency, so maybe this accounts for the fact that 98% of doctors claim to have discussed anxiety and fear with patients while only 54% of patients actually report that happening. Having not yet read through the entire study, I am unsure of the statistical significance of these numbers, and of the merit of sampling methodology, yet the numbers do seem to point to something work taking a look at.

So why is this important? For one, patients and doctors should be on the same page about information, especially since so many medical situations require outpatient attention and lifestyle changes (to some degree) by a patient. But these finding are likely just the tip of the iceberg when it comes to information assymetries in care, including other areas like nursing home, child care, outpatient services, etc. Without proper information, can patients and families really judge the quality of care? Do patients, families, and even insurance companies (...sadly) share these same miscommunications, resulting in real economic symptoms like adverse selection? How many extra costs do these discrepancies present?

This gap likely presents many costs, on all participants in medical care creating an imperfect market. In childcare, economist David Blau presented a robust model of the child care market, described as generally well-functions with a few valuation gaps. He does acknowledge the information asymmetries present in the market, especially in the gap between perceived and actual quality of care for children. Something similar likely occurs with adult care, like hospitalization, where the communication gap between doctors alters what the hospital believes to be quality care and what the patient feels they are actually receiving. Someone, like an insurance company, can likely find creative ways to capitalize on this discrepancy. As more similar studies to the one done by Olson and Windish emerge, the question is how these communication gaps can be ameliorated, at what cost, and at what savings.

The London Tube is famous for its "Mind the gap" caution signs. Those involved in care markets, especially patients and family members, should follow a similar motto to avoid stumbling into an information and quality gaps. Hospital and care center administrators, as well as policy makers and regulators too, may want to watch their feet. I am not knowledgable to make any suggestions on how to do this, but to me it seems like communication discrepancies may be somewhat solvable through technology, like accessible and transparent medical documentation that can be reviewed by doctors, patients, families, and insurers. This small study is a part of a much broader problem in care, with complex transactions and costs (both monetary and health), so solutions will likely never be that simple.

No comments:

Post a Comment