ABSTRACT
It is difficult to read a news feed or watch the nightly news and not see a story about national concerns over cost, quality, delays, access, or patient satisfaction in healthcare.1 These are serious and real concerns that are often showcased in the media by stories covering families forced to file for bankruptcy because of medical bills, deaths caused by medical errors or a diagnosis that came too late in a patient’s disease progression, or an elderly person dissatisfied because of the physical or logistical and intellectual challenges in navigating a healthcare appointment at a large multispecialty clinic.1 These issues are receiving substantial attention from a variety of key stakeholders, including the following:
1. Politicians who incorporate healthcare reform as a major aspect of their platform, calling for more accountability on the part of healthcare providers
2. Insurance executives who assert the value of competition and their role in coordinating care
3. Hospital leaders who see their revenues being linked to quality and satisfaction for the first time
4. Physicians trying to operate in an increasingly financially integrated system while lacking much of the operational infrastructure (i.e., information technologies) necessary for success
5. Patients who are poorly prepared to navigate the complex and costly healthcare system and are ultimately dissatisfied with their access to high-quality care2
The final group, patients, plays a particularly important role in the system given the comprehensive way in which they influence other stakeholders and the system in general. More specifically, patients serve as constituents of politicians influencing their perspectives through lobbying and, of course, directly at the polls during election time. Patients influence the performance of insurance companies when (a) selecting health plans if multiple plans and perhaps several insurance companies are offered as alternatives by employers; (b) accessing care because patients determine how much care and where to have it; and (c) managing paperwork and billing, following care delivery as engaged patients verify their charges. This latter practice is beneficial for insurers and third-party payers because some industry experts estimate that as many as 8 out of 10 hospital bills contain errors.3
