Recent conversations about changes to Medicare, the new ACO model, and the evolution of social media in the practice of medicine has caused questions to arise regarding the evolving role of patient within the healthcare space. Many have been using the word “consumer” as synonymous with today’s modern “patient”.
con.sum.er: one that uses a commodity or service
pa.tient: a client for medical service
Generally speaking, there are two widely held views about patients as consumers. The economist’s view is, to put it bluntly, horrified by the insinuation of patient as consumer. A more sociological perspective finds that the role of patients as consumers is a positive change that enables patients in the design of their care.
Here is a breakdown:
View 1: Patients are Not Consumers
On April 21st, Paul Krugman, Nobel Prize winning economist, wrote an op-ed piece in the New York Times called Patients are Not Consumers. In this piece Krugman maintains that a consumer-provider model in healthcare would erode the relationship that patients have with their physicians. Krugman says:
“Medical care, after all, is an area in which crucial decisions — life and death decisions — must be made. Yet making such decisions intelligently requires a vast amount of specialized knowledge. Furthermore, those decisions often must be made under conditions in which the patient is incapacitated, under severe stress, or needs action immediately, with no time for discussion, let alone comparison shopping.”
I saw similar sentiments from a physician blogger in Why Patients are Not Consumers. This blog outlines three major reasons that make the healthcare market different than other markets where a consumer-producer relationship is functional: 1) Health care is generally not a refusable or elective service, 2) there is an asymmetry of information, and 3) purchasing power is concentrated in the hands of a very small number of “consumers” (half of health care costs in the US is concentrated in 5% of the population).
View 2: Patients are Consumers
There is another school of thought that believes that involving patients in healthcare as consumers actually strengthens their relationship with their physicians. Traditionally, physicians have been viewed as demi-gods, and there was hesitancy to question the information provided by them. Patients as consumers change this dynamic by making patients and doctors partners in resolving healthcare needs. According to IHI, this decreases costs by involving patients in the design of clinical care similar to what is proposed under the ACO model.
In Patients As Consumers – Managing Healthcare and the Healthcare Team, Teri Robert provides what I believe is a more sociological perspective of patients as consumers. She states that patients have changed. They have more information as health stories grow in television, magazines, and social media. Patients as consumers of information are demonstrating how they can change their lifestyle and impact their health. With the amount of health information consumed online, for better or for worse, patients are demonstrating at record-high rates that finding answers isn’t always the doctor’s responsibility alone. The doctor is simply a very important point of information consumption. This new definition of consumer also enables patients to take more ownership over the physicians they select. As Robert states, “If we aren’t receiving the medical care we feel we need, it’s time to purchase those health care services elsewhere.”
Ultimately, I sense a more balanced doctor-patient relationship evolving in exam rooms nationwide. Whether this makes patients “consumers” or not is still up for debate.
What do you think? Are patients consumers?
