How We Choose--Looking at household healthcare choices in the U.S. and India

If you live in the U.S. or another developed country, chances are the life you lead is very different from that of a poor villager in India—but the way you make important choices may not be. Recent findings from a study by the Robert Wood Johnson Foundation and the Harvard School of Public Health demonstrate that in the U.S., familiarity trumps data when it comes to picking a hospital. In other words, Americans are more likely to frequent a hospital they or someone they know had an experience with, than a hospital formally recognized for better quality. Interestingly, FAI research in India shows similar results. The study “Can Insurers Improve Healthcare Quality?” reveals that when provided with information on who is the best quality care provider by their MFI or microinsurer, clients still supplement this information with information from informal sources.

Another interesting parallel: Based on evidence demonstrating that the uninsured have worse health and higher mortality than the insured population in the U.S, you might be surprised to learn that the uninsured do not necessarily receive worse quality of healthcare (see page 9). FAI research found the same to be true in our India study—that healthcare insurance status is not significantly associated with better quality care for patients.

Such parallels are interesting, especially as the U.S. undergoes major healthcare reform. The studies provide valuable insight on how to effectively direct resources to maximize the impact of healthcare and health insurance on public health. While improving access to health information is important, reframing the way it is presented may also be key to pointing people toward high quality services. Likewise, increasing access to health insurance is important, but concentrating efforts on improving overall healthcare delivery itself is also critical.