Giving health care to the consumer Featured

6:01pm EDT October 20, 2004
Although health care costs are rising at a slower rate this year, employers and their employees are still looking for solutions that will keep health benefit costs in check and coverage affordable while maintaining quality of care.

Until recently, consumers had little reason to learn about and understand the true costs of their care. That's because employers who offer health insurance have tended to absorb the vast majority of their employees' health insurance premiums and a large share of claims expenses.

In an effort to maintain a healthy bottom line, some employers are considering solutions that miss a key ingredient necessary for success and employee satisfaction -- consumerism. Employers are reducing benefits, increasing employee premiums and out-of-pocket costs or dropping coverage altogether.

However, technology offers a fresh approach. A new era of consumerism is emerging; employees can now be engaged in choosing and using their benefits wisely.

A fresh approach to rising health care costs
Consumerism is inevitable. While achieving short-term success, every other proposed solution -- government control, employer control, provider control and insurer control -- has ultimately proven inadequate to satisfy consumers and tame the medical cost monster.

Surveys show most consumers believe the total cost of a doctor's office visit is equal to their co-payment. As we enter this new phase of health benefits, the veil must be lifted so consumers understand the economic realities of their choices.

However, simply exposing employees to health care costs will not solve the problem. In fact, merely shifting costs to employees increases consumer dissatisfaction and may drive legislation to protect consumers. To be successful, consumers must have the information necessary to make wise choices, both in terms of cost and quality.

When people spend their own money -- and have access to good, actionable information to help them choose wisely -- they're going to be much better at controlling spending for themselves and their employers.

Health care costs today and tomorrow
While the power to strengthen the health care system and control health cost increases is mostly in consumers' hands, the system's other stakeholders have important roles, too.

  • Insurers must engage consumers, so they understand the true cost of their health care and make an effort to keep those costs in check. We must enable consumers to choose and use the benefits they need with the confidence that comes from up-to-the minute, electronically delivered knowledge. At the same time, we must continue to provide catastrophic medical coverage as a reliable financial safety net.

  • Political leaders must create a regulatory environment that encourages innovation and administratively efficient benefit plan choices and produces consumer-friendly comparison tools about health care provider cost and quality.

  • Doctors and other health care providers must help their patients become truly informed consumers of health care by explaining the range of treatment options and associated costs.

Most of all, consumers must gain a better understanding of the health care system. Through consumer-choice plans, they should be encouraged to investigate treatment alternatives and ask questions about the true cost and quality of services.

Ultimately, we must all work in concert if we're going to put an end to continually rising health care costs. If we stop pointing fingers and start pulling together, we can make consumerism a key factor in our heath care system, solving the cost crisis once and for all while increasing choice, value and quality for employees and their families.

Alan Guzzino is the president of Humana's Atlanta, North Carolina, and South Carolina market health plan operations and is responsible for the management, strategic planning and growth of those markets. Guzzino, an eight-year veteran of Humana, serves on the board of the Georgia Association of Health Plans. Reach him at Robert S. Wolfkiel is vice president of sales for Humana's Atlanta market and is responsible for managing and directing the sales initiatives, enrollment process and profitability of Humana's product portfolio within that market. Wolfkiel has more than 14 years of health care industry experience. Reach him at