​Where is the consumer when it comes to health care and health care costs? That's an important question and one that needs to be factored into any effort to change how we get and pay for health care in the future if the changes have any chance of succeeding. Recent results from a series of eight focus groups conducted by the Robert Wood Johnson Foundation (RWJF), give us a little window into that question. The focus groups took place in Philadelphia, Charlotte, Chicago and Denver and involved people who got their insurance from their employers and from the private market with deductibles of $500 or more, Medicare recipients and one group who were uninsured. Here's what they found: When it comes to cost, people think of what they have to pay for health care. They really have no broader understanding of “how insurance works and/or how doctors are paid.” While participants knew very well that the cost of health care was going up, they really don't know why but they do know “practically to the penny” what their out-of-pocket costs are, something RWJF said was a new development. For most of the participants, saving money on health care was a personal issue that related to having more money for other areas of their lives rather than because it was good for the country. But there's some good news here as well as health care tries to control and reign in costs and that is many participants in the survey didn't necessarily think paying more for health care was related to better quality of care. That surprised RWJF and frankly goes against what is usually referred to as the “Neiman Marcus” effect – the idea that if it costs more it's better. The conclusion – the consumer wants more information and there is room to engage them in what is changing and why. By Michal Regunberg, SM& Senior Vice President