I experienced one of the problems with American health care tonight: 94 eye care providers. While this may seem like a marvelous example of Kapitalism at work, I am worse off than if I had fewer options. Let’s delve into this.
It’s not that my eyesight has degraded, I think, but my last eye exam was 2 years ago. I have no spare contacts, and my glasses are scratched, so it’s time for a new exam, glasses, and contacts. My insurance year ends May 31, so that plays a role, too. Unhappy with my last eye doctor in Louisville, who took 6 weeks to schedule me and didn’t handle my insurance paperwork, I decided to search on my provider’s website. I entered my zip code, selected a 20 mile radius, and got over 200 possibilities. Well, Louisville is a fairly big city, and that’s basically the entire city, so that’s too much. Reducing the distance, within 5 miles of my zip code there remain 94 providers!
My insurance provides a PDF listing. On this list, I can see each provider’s name, gender, degree (OD, OPT, MD), associated company, address, and phone number. The symbol listings at the bottom have entries for “accepting new patients” and “not accepting new patients”, but none of the entries have either mark. A couple people list a second language, which would be useful if I would be more comfortable in French, Spanish, or Hebrew. That’s the best part, but I want English so it doesn’t decide things.
Overall, there is almost nothing here. There’s not even a description of the degrees. Which do I need? I have to head off to eHow to get a description. OPTs don’t do exams. ODs do general exams. MDs can handle more difficult cases and surgery. An OD should be fine for me. (This OD isn’t the OD Latin for Right Eye, by the way. Fortunately, in an example of good sense, OD and OS are supposed to be replaced with Right and Left. No more sinister Lefties!)
Another factor, I guess, is that I’m not looking at 94 providers, but rather a smaller number of centers. Most doctors, though not all, are associated with a clinic structure, like Kentucky Eye Care PSC, Vision First, or Dr. Bizers Vision World. I count 14 centers within 5 miles. This would help me somewhat, except there’s no general information about the centers. Google search sends me to healthgrades.com, which only has 77 listings for the entire city. That’s not much help. There are also ratemds.com and vitals.com, each with a few reviews. Most people, and even most groups, have none. I have no filter.
There’s not even a list of specialities, or areas, or programs. As a comparison, when searching for colleges there are a lot of providers organized into groups, like me. It can be overwhelming, and the USA might be better off with fewer larger schools. Yet there are listings, guides, and data. No such information exists for eye doctors. Continuing the analogy, one can make college visits and see sample classes. I don’t think there are sample eye exams.
Putting it all together, I have no idea who to select. I would do much better if Bellarmine’s human resources department had handed me 3 preferred choices, with commentary they had prepared. I might even do better if the plan had ONE choice that they, as more knowledgeable people, had chosen to be best. From their perspective, the transaction costs in dealing with 1 or 3 providers would be less than the dozens around Louisville. In the quest for “freedom”, we all have to pay greater transaction costs. And I, like other consumers, are asked to make choices without information or background.
I just don’t know. I’m in analysis paralysis, the the The Paradox of Choice. More is less, because I must spend much more time on the decision, plus I have a much greater likelihood of suboptimality, and thus am more likely to be unhappy. Author Barry Schwartz explained the problem in a TED talk. Mr. Schwartz mentions health care in his talk. As he notes, it’s not patient autonomy, it’s a shift of responsibility from an expert to a less able decision-maker.
There’s another good solution beyond my choice reduction, of course. In the comments on the talk, a Chris Grayson makes a good point: “Our problem is not too much choice but too poor filters. As choice multiplies, informed recommendation becomes increasingly valuable.” But until that happens for eye doctors, or Bellarmine frees us from the false benefits of Kapitalistic “freedom”, I still have to stare at those 94 choices with my old glasses, and not be totally blinded by choice.