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Physician Review Websites

As NIB, BUPA and HBF form the Whitecoat healthcare directory joint venture, it’s time to consider the pros and cons of online reviews of healthcare service providers.

The origins of healthcare provider review websites are grounded in a fundamentally inefficient healthcare market weighted in favour of the service provider.

Consider this: there is undeniable evidence that the treatment you receive and the price you pay for medical or allied health services will vary significantly from provider to provider. Yet until recently, consumers and patients have had little opportunity to gather the facts that enable them to adequately compare performance and costs before deciding on a provider. Conversely, health care providers require that patients put forward all relevant information to allow them to make the appropriate diagnosis. Do you see where I’m going?

International Healthcare Provider Review Websites

We go to Trip Advisor when looking for travel data, Zomato for restaurants and Amazon for books – but what are we really looking for? Many would say price comparison, and although this is partially correct, most people realise that purchasing a product or service is so much more than price alone – especially when you consider that almost everything can be made or done cheaper somewhere in the world. Quality and service are just as important, especially when it comes to health care. Patients are going online to be better informed before selecting a health care provider, with US statistics suggesting up to 65 per cent research medical service providers online before selecting one.1

Patients are going online to be better informed before selecting a health care provider

There are, however, problems with online reviews. To be meaningful they must use standardised rating systems. Additionally, they should take into account the nature of the particular health care provider’s practice. A recent study of US orthopaedic online reviews found that those in academic practice had significantly higher ratings than those in a hospital environment,2 which is sure to skew the rating. Similarly, a neurosurgeon who predominantly handles life and death cases in a hospital may get very poorly rated on outcomes when compared to neurosurgeons who routinely handle less complex cases.

Adding to the complexities is the fact that some US review websites rate their paying member providers ahead of other non-member providers even though they are ranked equally based on raw scores.3

There is also the psychology of reviews and again US research (based on dentists) has shown that dentists with the most reviews were rated more highly than those with fewer reviews.4

Online healthcare reviews, while not uniquely American, have been clearly established in the patient mindset so it is unsurprising that an Australian organisation should look at doing something similar.

Whitecoat’s Origins

Newcastle based NIB launched Whitecoat (www.whitecoat.com.au) in 2013, initially as a review website for allied healthcare providers to NIB health insurance customers. Some 30,000 providers, mainly optometrists, dentists and physiotherapists were listed on the website. The initial concept was to develop a system somewhat like Trip Advisor but without the shortcomings (such as properties inserting their own positive reviews of themselves). NIB’s review website was a closed loop system – before providing a review, the patient had to have attended an NIB registered provider and been billed by that provider. Even then, all reviews were moderated with about 85 per cent being posted.5

Initially, the Australian Dental Association openly rejected the concept as did the AMA, even though GPs were not listed.

NIB’s reason for developing Whitecoat was to help consumers find, choose and review healthcare providers based on their experience but there may have been other unstated reasons. For example, does NIB use the ratings to rank their own service providers for internal purposes or is this a move by NIB to drive down provider prices and thus insurance costs… or is this a competitive issue with NIB wanting to be first to market ahead of its major insurance competitors?

Whitecoat Joint Venture

Three years of experience with Whitecoat gave NIB the confidence and the data to propose the joint venture between NIB, BUPA and HBF. These insurers represent approximately 42 per cent6 of the AU$23bn private health insurance market7 making this announcement a potential game changer – not just for their own customers but all consumers of health and allied services.

Whitecoat already lists some 35,000 providers and has some 250,000 published8 patient reviews. The upgraded platform will allow ‘members only’ sub-sites to provide individual funds with the ability to offer their own members comparable cost information, and ‘preferred’ No Gap or Known Gap arrangements they have with doctors, dentists and clinicians.

In the future the site will be an enabler for automating everyday practice transactions. In a world where online and mobile services are becoming the norm, the health care sector has been slow and clunky. People should be able to find a service provider online, make appointments, fill prescriptions and pay or claim the bill.9

Risks and Opportunities

  1. Health Funds: Whitecoat will assist health funds in their drive to increase revenue and decrease costs. Health funds continue to seek opportunities to venture into vertical integration, whether it be through their own dental or optometry practices or online booking and billing systems as part of Whitecoat.
  2. Service Providers: While initially nervous, should have little to fear unless their service is poor or their price unrealistically high. The structure and integrity of the Whitecoat review system appears to be fair. The risk of a poor review in a small sample is easily resolved by the physician encouraging more patients to provide reviews. Further, service providers will now receive independent feedback on their performance, allowing them to learn from their patients and improve their service offering. Additionally, service providers will have the opportunity to participate in the Whitecoat automated systems including online appointments and billing.
  3. Patients: should be the real winners but, like other online review platforms, Whitecoat should form only part of the decision-making process.

Michael Jacobs is a business consultant and columnist for mivision. He was the former Chief Executive Officer of Eyecare Plus for 10 years until early 2015.

1. The Journal of the American Medical Association February 19, 2014
2. www.healio.com/orthopedics/journals/ortho/2015-4-38-4/%7B02c61d88-e0f0-488f-9b0b-b189a771b077%7D/online-reviews-of-orthopedic-surgeons-an-emerging-trend
3. www.webmd.com/health-insurance/insurance-basics/using-doctor-ratings-sites
4. Grabner-Kräuter S, Waiguny MK. Insights into the impact of online physician reviews on patients’ decision making: randomized experiment. J Med Internet Res. 2015;17(4):e93.
5. www.abc.net.au/news/2013-11-08/patients-to-review-healthcare-providers-at-whitecoat-website/5078040
6. www.apra.gov.au/PHI/PHIAC-Archive/Documents/Operations-of-PHI-Annual-Report-2013-141.pdf
7. IBIS World report summary www.ibisworld.com.au/industry/default.aspx?indid=525
8. NIB Media Release 29 July 2016 https://www.whitecoat.com.au/blog/media-release-29th-july-2016
9. Mark Fitzgibbon, Managing Director, NIB, Australian Financial Review, Aug 1, 2016