Employers flex their muscles as health care purchasers.

On one hand, the health care market place is unlike any other. It deals not with widgets, but with lives. On the other hand, the health care marketplace is just like others: its proper functioning depends on basic market forces and signals. Patients and other purchasers of health care, like large employers, need to exert those forces and send strong signals about their needs. But up until now, it seems as if the patient, who stands the most to gain or lose, has largely been a quiet recipient of whatever care comes his or her way. Employers and other organizations and agencies who purchase health care on behalf of patients also have significantly underutilized their leverage in the system. If there is any hope of improving the value of care by raising quality and shaving the upward trend of health care costs, the health care system needs both to play a more active role. Engaged health care purchasers-both individual and group-can stimulate some good, healthy competition in the health care system, and competition needs to be based on results. To determine results, we need accepted measures of quality and efficiency that make sense. Then, performance on those measures must be disclosed publicly. Only when this information is available to consumers and other purchasers of health care will they be able to make informed choices and reward effective and efficient health care providers.