Choice and representation in health care

Choice is often thought to be critical in health care, especially to foster quality improvements and lower costs. However, it is also recognized that in the current system there is significant representation of consumers, mem bers, and patients by physicians, employers, and health plans. Consent, acc ountability, and protections against conflicts of interest are necessary to ensure legitimate and effective representation. This article discusses the roles and responsibilities of physicians, employers, and other parties wit h respect to serving as representatives of health care consumers. The autho r concludes that to make representation more legitimate and effective in he alth care will require significant changes, which include (1) changing busi ness to a stakeholder theory, (2) involving employees in health care covera ge decisions, and (3) involving members of health plans in policy decisions .