No Debate: Patients = Consumers

Rick Johnson, for HealthLeaders Media, March 12, 2009

This is becoming one of those "get over it" moments for healthcare professionals. You can resist the notion all you want; the fact is patients more and more see themselves as consumers, and that's not necessarily a bad thing.

Sure, you might look back fondly on those paternalistic Marcus Welby days, when a patient not only knew his doctor's name, but took the physician's word as gospel. But the good Dr. Welby was canceled a long time ago, and today far too many people have limited access to care, or their employers are shifting more of the cost onto them.

With large employers, like GM, wrangling to get out of the bad business of paying for healthcare, it probably should not have surprised me that our new HealthLeaders Media Industry Survey reports that top healthcare executives say consumer-directed healthcare offers the best hope for the industry. (See below.)

Survey responses of 1,119 senior healthcare executives: In your opinion, which model offers the best hope for healthcare?

  • 33.6% - Consumer-directed healthcare
  • 25.11% - Government-mandated universal health insurance
  • 21.89% - Government-funded universal healthcare
  • 9.92% - Employer-sponsored healthcare
  • 9.47% - Other

Many private global providers have recognized this shift and have developed a value equation based on service excellence, quality, and cost. Here in the States, there are patient-centered care movements that combine the best of quality care and consumer engagement, but too few hospitals and medical groups have the vision or wherewithal to design these kinds of experiences.

Whether to call them patients or consumers might sound like a debate over semantics. Far from it. I read recently a humorous essay on the Aggravated Doc Surg blog on this topic. The self-described general surgeon and blog author takes the idea of healthcare consumerism to the rhetorical extreme by wondering what healthcare infomercials might look like. (As a related note, at a recent conference a healthcare marketer seriously floated the idea to me of infomercials to promote medical tourism.)

This physician blogger—and there seem to be more of them every day—sums up his argument this way: "It is my privilege and duty to care for people who come to see me—as patients. There is a respect involved with that term which is absent from the term consumer, and which is important in maintaining the dignity of the individual as he or she interacts with physicians, hospitals, and other places where medical care is delivered. When we lose that perspective—when physicians are seen only as 'providers,' or interchangeable widgets, and when patients are seen only as 'consumers'—we will have totally lost any semblance of dignity as a profession, and by extension, as a people."

That might be a powerful emotional appeal, but then everyday experiences with the healthcare system are pushing people to see themselves not as patients but as consumers. I'll give you a couple of anecdotes from personal experience, but I bet you have plenty of your own.

As a healthy Gen-Xer (I turned 37 earlier in February), I can say honestly that even though my employer provides good health insurance, I've always had to be a mindful healthcare consumer for myself and my young family. When I visit a primary care physician, the impression I get is that my visit is costing the doctor money. He runs through his assessment as quickly as possible and makes a point to remind me that I don't need to schedule another visit for at least two years. The last time I saw him was about three years ago, and I'm really in no rush to go back anytime soon.

And I will never forget the tone of my son's pediatrician when we told him we were concerned about our toddler's development. We said that our boy, then only 3, seemed resistant to his peers, hypersensitive to sound, and was fixated on numbers and maps. This experienced senior physician dismissed our observations as he checked a few boxes off my son's chart. "Yes, I bet he knows all his shapes and colors by now, too," he said. It was more than a year later when our son's preschool teacher suggested that we have him tested for Asperger's syndrome.

Don't forget that we are among the fortunate ones who have health insurance, and I hardly consider these hard-luck stories. The fact is that I'm just like most people. When it comes to my health, I have to do my own homework and make my own decisions. When it comes to my kids, I end up getting the best help and useful information from teachers and non-physician providers. The tired notion that as a patient I have some special connection with a physician who partners in my health is an alien concept. I don't blame physicians for this; it's just the way the system has evolved. As a result, I have no choice but to be a conscientious healthcare consumer.

Consider this: In a down economy, U.S. employers are saying they cannot keep up with the cost of healthcare, and paying an average of $8,482 per worker for health coverage puts them at a competitive disadvantage globally. For the first time, American workers in 2008 on average paid more than $1,000 for employer-sponsored insurance coverage, according to benefits consulting firm Mercer, which is up 17% from $859 in 2007. What's more, the high-deductible, consumer-directed insurance trend is only expected to escalate in the coming years. Employers want workers to pick up more of the healthcare tab so that they will make smarter and more cost-effective health choices.

Healthcare consumers are a big part of the future of healthcare, and providers will need to interact with them in new and innovative ways.

Rick Johnson is senior online editor of HealthLeaders Media. He may be reached at
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