Patients as Consumers? A Healthcare Cure?

by Bradley Miller on July 15, 2010

Have we been lulled to accept this as the typical patient relationship with healthcare?

Last month I attended the Microsoft Connected Health Conference in Bellevue, WA. It was an interesting conference because although there is close to $20B in ARRA stimulus dollars to be chased for electronic health records (EHRs) and health information exchange (HIE), “consumers” were on the tips of everyone’s tongues – they stole the show.  Everyone at the conference was talking about how patients needed to act more like consumers and providers and payers needed to treat patients more like consumers.  From hyperzealous entrepreneurs to entrenched Microsoft Research folks, “consumers in healthcare” was the topic on the tips of everyone’s tongue.

To me it seems all a bit funny and odd.  What does it even mean to be a consumer in healthcare?  Particularly, what is the difference between being a patient and being a consumer?  I think it has partly to do with how the “well” (AKA people who aren’t sick) interact with healthcare resources and to continue to be well. From healthy living and eating to tracking health information in a personal health record (PHR).  Taking control of your care and doing all that you can outside the care setting (hospital, practice, etc) seems to be an important aspect in transitioning from a patient to a consumer in healthcare.

I completely agree with the concept of utilizing consumer engagement techniques and practices to engage the well into keeping healthy.  From employing game mechanics (Nike+, rewards for consistent health monitoring, etc) to tracking healthy stats or improving an already healthy lifestyle should be encouraged at the consumer level. This includes thinking about how we as a population need to reconsider the foods we consume.  The overall goal for actual healthcare is to engage people more in their care – to both improve outcomes and to engage them on costs and potentially decrease costs.

Should patients act more like a consumer who's car shopping? What if we as patients were more aware of costs, benefits and risks?

However, another key part of being a consumer in healthcare is being aware of the cost of care.  Just like being a consumer at a car dealership, patients should be aware of the cost of the product they’re purchasing.  The only difference is that in healthcare patients have traditionally had costs paid for by insurance companies and therefore been aloof of what their care actually costs – both in terms of system resources and financially. Very few patients even do research prior to their care – some do, most despite the availability of vast knowledgebases on the web, few people take advantage of those resources as they do when making other large purchases.  How should taking more of a consumerist role affect care?  How can financial awareness in healthcare lead to better care, rather than the rationing of care? When was the last time you even looked at a medical bill or got a cost estimate for care prior to receiving that care?

We should already be encouraging patients to understand the cost of care.  However, one of the traditional roadblocks to making patients aware of costs is that it’s incredibly hard to get access to cost data.  Virtually everything else we consume has a transparent cost.  However, in healthcare there’s no real list of what certain types of care or procedures costs.  Except for those we have to pay for in cash, like cosmetic surgery.  As consumers we know more about what it costs to insert breast implants than we do about what a life-saving surgery (like an appendectomy) costs.  Costs are anything but transparent, and the odd thing to me is that insurance companies should be more open about cost structures – it might even save them money if people decline unnecessary, expensive care.

Traditionally, being a patient came with very few responsibilities with respect to the doctor-patient relationship.  You arrive at the doctor’s office on time, answer the doctor’s questions, listen to the care instructions and then take your medications or do your therapies.  It was and still is very paternalistic in that sense.  When these patient norms were set, the cost of care was incredibly low, but now more expensive drugs and techniques are taking over.  Nowhere in that traditional role were patients asked to  “think about cost” – it was just assumed that it would be covered.

Being a consumer implies that you have the freedom to walk away from a purchase or product if it’s too expensive.  Our medical ethos doesn’t allow for this in medicine.  Or at least it shouldn’t for the right care and therein lies the catch.  People need to understand cost and reduce their healthcare usage, while maintaining a high level of care.

With little mind to costs, America's healthcare rates are increasing at 8% per year. We need to get smarter with how we spend those dollars.

So, patients need to better understand what their care costs – how we do that is for another post.  But, for now I’d like to propose that patients remain patients, and we continue to consider how to leverage consumer principles and awareness to help drive patients helping to keep the cost of care down.  We’re spending an inordinate amount of time and effort trying to engage patients with their data.  I think connecting patients to their cost will have a much more dramatic effect, but it needs to be done carefully.

I’d like to suggest that while the concept of consumerism is being applied to being a patient, I think that patients should remain patients, but become more engaged with their care.  We should begin to act and think more like consumers when it comes to healthcare, but we still need to be patients at some point.  More on that in a future post.

What do you think? Do you want to know what your healthcare costs?  Should cost ever be a determining factor in whether someone receives healthcare?

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