Jakob Nielsen's company has written a detailed analysis of how the Federal Health Exchange screwed up usability:
The HealthCare.gov team has suffered what most web professionals fear most: launching a broken web application. This is particularly harrowing given the visibility of the website in question. The serious technical and data issues have been covered extensively in the media, so we won’t rehash those. Instead, in this article we focus on how to improve the account setup process. This is a user experience issue, but fixing it will also alleviate the site's capacity problems.
Account Set-up Usability is Mission Critical
Account setup is users’ first taste of a service. A suboptimal account setup can spawn 3 problems:
- Increased service cost: When people can’t self-service online and you have no competitors, they call you. Call-center interaction is more expensive than web self-service. In 2008, Forrester estimated call-center calls to cost $5.50 per call versus 10 cents for a user who self-services online.
- Increased cognitive strain: The instructions for creating usernames and password in this flow (which we address further along in this article) require a great deal of concentration, and if users don’t understand the instructions, they will need to keep creating usernames and passwords until they are accepted.
- Halo Effect: Account setup is the first in a series of web-based interactions that users will need to conduct on HealthCare.gov. A poor experience with this first step will impact how people feel not only about subsequent interactions with the site, but how they feel about the service in general and the Affordable Care Act as a whole.
The discussion around our office hinges on two things other than usability: first, give us $2 million (of the $400 million they actually spent) and we'll build a much better site. Second, the biggest problems come from the insurance companies on the back end. Users don't care about that; they just want to get health insurance. As Krugman says, though, there really wasn't a way to get the insurance companies out of the equation, and that, more than anything, is the foundation of all these other problems.