Why “Shopping” is a Problematic UX Metaphor for Considered Purchases Such as Healthcare

April 14, 2016

Over the last decade, there have been many shifts in healthcare. Among these has been a growing awareness of an increase in consumer-driven healthcare and consumer-driven health insurance plans.

The definition of these terms can vary depending on whom you are talking to, but for our purposes:

Consumer-driven healthcare is healthcare in which the consumer plays an active role in the decision-making. They choose their doctor, medical facility, and potentially what medical procedure to have performed.

Consumer-driven health insurance plans typically combine a high-deductible health insurance plan with a tax-advantaged account typically a Health Savings Account (HSA) that can be used to pay deductibles and other qualified healthcare expenses.

Benefits and Drawbacks

Advocates say that these shifts will ultimately encourage greater awareness and cost-consciousness among consumers, increase transparency in the healthcare space, and improve health outcomes.

Critics say that these shifts only benefit employers, the wealthy, and the healthy and will ultimately leave those most in need of healthcare unwilling and unable to meet their needs.

As with most things, the truth likely falls in the middle.

What we do know is that consumer-driven healthcare has transferred some of the control, choice, and decision-making away from providers and insurance companies and toward consumers. This shift has caused a number of noticeable changes in the way healthcare is defined, sold, and administered.

A “Shopping” Experience

Among these changes have been the emergence of both public and private healthcare exchanges and the transition of selecting health insurance or healthcare to a “shopping” experience.

On the surface, it makes sense that using a “shopping” model for insurance might promote consumer-driven healthcare. After all, everyone knows Americans like to buy stuff—why not harness our consumerism to encourage us to take more responsibility for our healthcare?

In reality, just because you buy it doesn’t make it shopping.

While the trend of creating “shopping” experiences for healthcare has grown in popularity, our research indicates that within the shopping context, consumers find task completion challenging, make ineffective or incomplete decisions, and struggle with confidence. As a result, businesses struggle to successfully sell and implement health plans that consumers have purchased without proper understanding and adequate support.

Considered Purchases

The things we purchase fall on a spectrum from considered purchase to an impulse buy.

A considered purchase is a complex buying decision with multiple variables and a significant aspect of risk/reward attached.

  • Considered purchases affect our finances and our lives over an extended period of time.
  • They require meaningful investigation and deliberation prior to the transaction itself.
  • They often require the input of multiple stakeholders in the purchasing decision.

Both consumer and commercial products can fall into this category, and healthcare is a prime example of a considered purchase.

Whereas impulse purchases and other single-interaction purchases lend themselves to the use of shopping metaphors, considered purchases do not.

Considered purchases require a much greater level of education and explanation in both the research and selection process than most shopping experiences.

“Shopping” for considered purchases such as healthcare ends up failing both consumers and businesses. Let’s explore why:

Shopping is largely optional.

There are no Federal laws and associated penalties about whether you buy a new pair of shoes or the latest best-seller from the New York Times list. You get to decide if want to buy an umbrella in preparation for the spring or if you’re going to dash from door to door and risk getting wet.

Not so with healthcare. It’s required. If you don’t purchase it there will be penalties.

Take a look at the number of articles, classes, and resources directed at reducing cart abandonment rates and improving conversion rates for any retailer and you’ll understand why a “shopping cart” metaphor is the wrong metaphor to use for a required purchase.

Many people are are accustomed to using shopping carts as a holding place for possible purchases. There are no consequences associated with leaving shopping carts abandoned and the items in them un-purchased. Not so with healthcare. If you fail to make an insurance selection, the consequences include a tax penalty or a default selection being made on your behalf.

There are no retailers that will fine you for not renewing your magazine subscription. There are no retailers that will automatically make a purchase for you when you fail to complete a transaction- Yet this is how many private healthcare shopping exchanges experiences behave.

Shopping is not time bound.

One of the benefits of living in a consumer-driven economy is that you can typically find the products you are looking for year round. Want a swimsuit in November? No problem. A ski jacket in the middle of July? Sure thing.

Not so with healthcare. There is a time limit on when it is available. Unlike swimsuits and jackets, you can’t make a healthcare decision and purchase year-round, you have to do it during predefined open enrollment periods.

Considered purchases such as healthcare require reminders, alerts, and other tools to enable users to understand relevant time constraints and implications of inaction.

Purchases are returnable.

If you compared blenders, buy one in the mid-price range, and decide after your first smoothie that it doesn’t blend kale to your satisfaction, you can return it. No such luck with your health insurance.

If your child develops an allergy after you’ve purchased a “Bronze” plan, you’re on the hook for the first $8000 of expenses before your insurance kicks in. There’s no way to exchange your health plan for a “Gold” plan with a higher premium and a lower deductible. You’re stuck with it – and the associated expenses– for a year.

Considered purchases such as healthcare require decision support tools and stepped processes that let users model and clearly understand the implications of their decisions.

Shopping is typically a singular experience.

With the exception of buying a subscription, most of the time we buy something, it is a finite amount. If we take a chance on a new shampoo that turns out not to eliminate frizz as promised, we can always buy a different type of shampoo the next time we’re at the store. If you pick a health plan only to realize that none of your doctors are considered “in-network” you can’t pick a different network the next time you need to see a specialist. You’re stuck with the plan and the choices until the following year or your stuck paying more to see the doctor you really want to.

Considered purchases such as healthcare require calculators and other modeling tools that enable users to understand all relevant costs over the course of the plan year, not just the monthly premium.

Considered purchases need special consideration, a smart strategy and approach.

This doesn’t mean that you can’t incorporate aspects of a shopping experience into a considered purchase such as healthcare, but it does mean that you need to be smart about the elements you use, when, and why.

At Crux Collaborative, we have been designing effective tools that support healthcare decision-making, selection, and usage for nearly two decades. If you’re embarking on a consumer-driven healthcare project that supports user decision making and purchasing, we’d love to talk about how to optimize the experience to meet your business needs and let your users succeed.

By Mahtab Rezai
Principal & CEO

Mahtab has spent nearly two decades as a user experience designer, researcher, strategist, leader, and mentor. She has designed user experiences for companies ranging from startups to the Fortune 50.

View Mahtab's Bio


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