Consumers look to insurers to lower health care costs

A consumer survey shows that more people expect health insurers, rather than physicians, to help them sort through the health system reform law and lower the cost of health care.

"We were surprised about how high expectations were for insurers to play the role of an educator, and also for them to be accountable to lower costs. It's really health insurers here who consumers are looking to make a difference," said J. Mark Carr, managing partner of South Street Strategy Group, a consulting firm affiliated with Chadwick Martin Bailey, a Boston-based market research agency that conducted the survey.

The company surveyed 1,504 adults, who reflected the demographics of the country in terms of age, level of education and race. Given a list of groups to choose from (they could pick more than one), 61% of respondents said insurers should be responsible for educating the public about health care reform. Only government was chosen more often, at 74%.

"This represents both an opportunity and a challenge for insurers to step out and be more of a leader, educator, a trusted adviser to the consumer -- or not, and miss expectations," Carr said. "Not all health insurers have embraced that role, but there's an opportunity to move forward and be proactive."

Asked who should be responsible for lowering health care costs, 75% selected health insurers, higher than any other choice.

By contrast, 34% said medical professionals should provide information about reform, and 41% said doctors and nurses should be responsible for lowering health care costs.

That may not mean everyone trusts health insurers more than physicians, however. In a follow-up interview, one unnamed respondent said: "Medical professionals are a more trustworthy source and should understand more about what they will and will not do as a result of reform. ... If a patient asks a doctor, 'Is a death panel going to kill me because you tell them I'm ill?' the doctor can say, 'No, that's ridiculous.' "

Given that the reform law mainly reforms the insurance market, it's possible consumers believe insurers are going to be the best reference for what is changing, said Tim Lee, principal and consulting actuary in the Houston office of the consulting firm Milliman. "Nobody in any industry understands it better than people who work in the insurance industry."

Robert Zirkelbach, spokesman for the health insurance trade group America's Health Insurance Plans, said insurers have done what they can to help lower the cost of care, including creating disease management programs, providing incentives to take generic drugs and investing in health information technology.

Lee called the survey results about who should reduce costs "a combination of funny and surprising."

He said there could be a couple of explanations for so many people saying insurers should take responsibility for cutting health care costs: One is that they may remember insurers' success at cutting costs in the heyday of managed care in the 1990s, and they are willing to see some of those methods return.

Lee said consumers will require a great deal of education to remain open to changes that might keep them from seeing the doctor of their choice or create more hoops for their doctors to jump through.

"Ultimately, it's going to be up to the doctor, the hospital and the consumer to control the cost," he said.

But it might be giving the public too much credit to think they are ready for insurers to bring back tightly managed care, Lee said. It's possible that consumers are considering only their own insurance premiums when it comes to health care costs: "What they may be thinking is, 'Health care costs are manifested in my premium rate ... so clearly the health insurance company must be responsible.' "