Responsive consumerism: empowerment in markets for health plans.
BACKGROUND
American health policy is increasingly relying on consumerism to improve its performance. This article examines a neglected aspect of medical consumerism: the extent to which consumers respond to problems with their health plans.


METHODS
Using a telephone survey of five thousand consumers conducted in 2002, this article assesses how frequently consumers voice formal grievances or exit from their health plan in response to problems of differing severity. This article also examines the potential impact of this responsiveness on both individuals and the market. In addition, using cross-group comparisons of means and regressions, it looks at how the responses of "empowered" consumers compared with those who are "less empowered."


RESULTS
The vast majority of consumers do not formally voice their complaints or exit health plans, even in response to problems with significant consequences. "Empowered" consumers are only minimally more likely to formally voice and no more likely to leave their plan. Moreover, given the greater prevalence of trivial problems, consumers are much more likely to complain or leave their plans because of problems that are not severe. Greater empowerment does not alleviate this.


CONCLUSIONS
While much of the attention on consumerism has focused on prospective choice, understanding how consumers respond to problems is equally, if not more, important. Relying on consumers' responses as a means to protect individual consumers or influence the market for health plans is unlikely to be successful in its current form.
Elbel
Brian
B
New York University School of Medicine, NYU Wagner Graduate School of Public Service, 423 E. 23rd Street, 15120N, New York, NY 11217, USA. brian.elbel@nyu.edu
Schlesinger
Mark
M
D000293:Adolescent; D000328:Adult; D003256:Community Participation; D003258:Consumer Behavior; D005260:Female; D006264:Health Benefit Plans, Employee; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011209:Power, Psychological; D014481:United States; D055815:Young Adult