October 24, 2013
This is #16 in a series of Access to Care Reports. (See also postings by Mitchell Law Office)
The “rough launch” of the Affordable Care Act (ACA) Health Exchanges has been greeted with wide-ranging “surprise” and criticism. But an advance look at typical consumer shopping behavior would have done a lot to help federal agencies anticipate—and cope with—the situation.
And such insights could have helped increase understanding as to how access to care depends on the ways in which health insurance is purchased.
When consumers are shopping for unfamiliar products, there are fairly typical types of behavior that may be expected. First comes browsing—looking over the product as part of an initial survey of the landscape. Usually included is comparison shopping to examine the full range of “products and models” that are becoming available. Any barriers to browsing—such as long lines and out-of-stock items—can rapidly lead to frustration.
Then comes a period of delay and thinking over the options, often while the potential buyer talks things over with family and friends, and perhaps surveys available “ads”. This stage often does not involve rigorous evaluation, but is targeted toward developing a level of comfort with pending purchases.
Tradeoff time involves the pre-purchase narrowing down of options by trying to decide which product is the best “fit”. Reactions may be based not only on “the numbers” but also on “packaging” and emotional responses. Consumers can be fickle in their reactions, and in the ways that they respond to packaging and branding in order to become comfortable with a purchase.
Selection-and-purchase time finally comes, with something of a “hold-your-breath-and-hope-for-the-best” dynamic. A purchase is often made not with pleasure, but with self-imposed pressure.
Afterthoughts may lead to buyer satisfaction or remorse. In extreme cases, remorse may lead to trade-ins and shifts to alternative purchases (think after-holiday returns). However, satisfaction may result in “talking up” a purchase.
The new Health Exchanges can be understood from this general perspective. Browsing results in many store visits. The initial surge in online visitors should have been predicted, and technology implemented to accommodate “lots of lookers”. Instead, the Exchanges had early problems with “crashing”.
The delay and thinking phase results in a predictable drop-off in activity. For the ACA, critics are taking this decline in activity as a sign of program failure, while advocates don’t know what to think.
Tradeoff time won’t come until the time for purchase nears. This will be a critical time for outreach and marketing of the ACA.
Selection and purchase may result in a peak of last-minute activity. The Exchanges should be prepared for a last-minute surge.
And afterthoughts should remain a constant concern for those implementing the Exchanges. High-level outreach and advertising must continue well after the peak to prevent remorse and backlash directed at the ACA.
Attorneys can help clients better assess their situations by basing advice on this expected cycle of activity.
And attorneys may also note that this same cycle applies when potential clients shop for legal assistance.
More on related ACA and access to care topics may be found in a recent book by the authors that describes implementation of the ACA, and in a new Practice Guide by the authors that addresses funding and access issues in health care.
Previous installments of “Access to Care Reports” address the various ways in which access to care issues are affecting legal practices: