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The proliferation of health care consumer reports (also known as "consumer guides," "report cards," and "performance reports") designed to assist consumers in making more informed health care decisions makes it vital to understand the perspective of employers who provide the vast majority of health insurance to the working population regarding the use of these reports. There is little empirical evidence on how consumer reports are used by employers to make health care purchasing decisions. This study fills that gap by surveying 154 businesses in Boone County, Missouri, regarding their evaluation of a consumer guide. The majority of employers surveyed indicate that the report will not have a direct effect on their health care purchasing decisions. However, they indicate that the reports are "positive and worthwhile" and their responses reflect a favorable view of the health care organization that developed and disseminated the report. Additionally, findings indicate that employers generally prefer consumer reports as a means to compare local health care institutions, rather than reviewing national averages to locate the same information. Report developers should take precautions to determine the intent of such reports, as they may not achieve the objective of changing employers' health care purchasing behavior. Key words: consumer guides in health care, performance reports, consumer reports, patient perspectives, consumerism, employee health benefits, health insurance purchasing.
Over the last decade, there has been a proliferation of consumer reports designed to assist consumers in making more informed health care decisions ranging from the consideration of health care insurance options to the selection of primary care and specialty physicians, as well as the site of hospitalization. These reports have been developed and disseminated by government, accreditors, business groups, and provider organizations. (1) Currently, however, there is little empirical evidence on how either consumers or providers use such consumer guides or report cards. (2)
Since employers drive the initial health care purchase decision through their provision of health insurance to their employees, (3) it is vital that employers' perspectives be understood with regard to these consumer reports and how, if at all, the reports are used in employers' decision-making processes about the health coverage they provide their employees. The majority of health care reform plans at both the state and national levels in the last decade include the use of consumer guides as a method to assist consumers in health care decision making. (4) Thus, it is important to raise several questions, including:
* Is it a wise public policy to invest funds in order to develop and disseminate these reports?
* How, if at all, are these reports used in health purchasing decisions, including the selection of health insurance and the selection of a physician and hospital?
* What are consumer and employer perspectives on consumer guides?
The consumer perspective was described in a recent study of patient views on consumer reports reported in this journal. Longo and Everett (5) found that sections of a health care consumer report were rated as "most interesting and/or helpful" based on the rater or a family member of the rater having the disease (e.g., cancer) that was dealt with in that section. This suggested a good deal of selectivity in patients' reading of the consumer guide. We consequently concluded that consumer guides must target particular …