When experts talk about cost effective medical care, patients don't listen.
However inartfully articulated, it's been a central theme of the Obama administration's push on health care and on the lips of health experts for years: More health care is not necessarily better health care.
But patients are far from convinced.
The journal Health Affairs just surveyed more than 1,500 patients with employer-provided insurance, including dozens in focus groups and one-on-one interviews.
The "pervasive themes" from respondents, according to the authors, were "more is better, newer is better, you get what you pay for, (and) guidelines limit my doctor's ability to provide me with the care I need and deserve."
Such findings are frustrating for experts who have spent years trying to communicate that those things are not true. And they actually imperil efforts to alter hospital and doctor payments to reward quality. They also discourage consumers from seeking higher quality and more cost-effective care, the researchers say.
"For those who believe that all medical care meets minimum standards and that more care is better, differentiating among physicians, hospitals, or other providers based on quality and efficiency profiles is likely to meet with resistance," they write.
Their own survey shows that only 41 percent of respondents agree that employees should pay less if they use doctors who rank highly in quality measures. Also, only 47 percent thought that employees should pay less for treatment that's been shown to work better.
Of course, it doesn't help their education efforts that Republicans have been hammering at the new health law's "comparative effectiveness" provisions, calling them Democratic efforts to ration health care.
Still, those pushing the use of evidence-based medicine aren't giving up.
The study's authors have developed a communication toolkit to help employers and unions better explain the concepts behind health care quality and cost-effectiveness to patients. It's available on the National Business Group on Health's website.