What’s up, doc? Negotiating in healthcare

Most of us spend more on healthcare than we’d like to—more, in some cases, than our annual car or mortgage payments. That being the case, why do we spend so much time negotiating the terms of our cars and houses, and so little the terms of our healthcare?

Frankly, the negotiation professor in me just doesn’t know. From my perspective, a few simple principles from the research literature on negotiation can make our healthcare much more negotiable. Just a few illustrative examples:

  1. Setting high aspirations. Negotiation research consistently shows that those who set and stick to aggressive goals tend to achieve better outcomes. With respect to our own bodies, though, I suspect many of us are dissuaded from our goal of ideal health when a well-intentioned doctor tell us “there’s nothing wrong,” or “you’re just fine,” even when we know there is and we’re not.
  2. Reiterating our core interests. Negotiation research shows that the most effective negotiators are those who hew to a consistent script—reiterating their core problem or motivation as consistently and repeatedly as possible. This seems particularly important in healthcare, when we often have to answer the very similar questions of a seemingly endless series of people. On a visit to the ER, for example, we might have to state our symptoms to the front desk, triage nurse, attending nurse, doctor, radiologist, and so it goes. The more consistent our message to each person, even in response to slightly different turns-of-phrase, the better our chances of proper treatment.
  3. Cultivating an alternative: The best negotiators always develop an alternative possibility—another car or house they’d be willing to buy, for example. Negotiating the terms of an alternative affords them power in their primary negotiation but also, importantly, helps them learn about whatever they’re negotiating. What price should I really offer for my preferred Corvette? Some of us cultivate an alternative in healthcare by obtaining a second opinion. But I suspect that some of us don’t because we think the doctor will get offended. Assuming we’re at least as motivated to learn about our health as our cars, I’d suggest we should.
  4. Asking questions: The best negotiators ask a lot of questions. Indeed, they probably use their listening ears more than their speaking lips. Well, few contexts are quite as rife for questions as the cryptic explanation of benefits. $392.54 for an octowhatgraphy with Dr. Whosehisname? I don’t know about you, but I’ve found that calling the insurance company and asking about it not only helps me mitigate confusion. It also turns up quite a few clerical errors that end up saving me money.
  5. Just asking: Asking a lot of questions is great, but even more basic is asking in the first place. The best negotiators are those who simply ask for whatever they need or want rather than expecting their counterpart to guess. But I suspect that few of us really ask for what we want in healthcare, mainly because we think we can’t—especially with a high-status doctor across the table. Lower prices, less invasive procedures, fewer unnecessary appointments: it’s all worth an ask if it matters.

In short, few aspects of our own lives are more important than our health. So why not do what we can to negotiate a healthier deal?

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