Sunday, April 5, 2015

The Opportunity for Consumerism in the American Healthcare Delivery System

My social media compatriot and editor-in-chief of Health IT Outcomes Ken Congdon recently wrote an article titled “The Problem With Consumerism In Healthcare.”

This was a good opinion piece that, in my opinion, really addressed more than one issue. In terms of Ken's take on healthcare consumerism, I think he's conflating the labeling of a movement for a more informed, involved healthcare patient consumer with the insanely over-regulated pharmaceutical industry and profit motive endemic in America and its healthcare delivery system. Consumerisn in healthcare is about putting more and better information into the hands and minds of an increasingly health literate American populace. I won’t address the longer, more detailed part of the article comparing how past and current pharmaceutical market realities bode ill for healthcare consumerism as I think these are largely two separate albeit related issues.

Here’s my take on healthcare consumerism

For too long people have just gone along with what the medical profession, health plans and supporting industries (device makers, pharmaceutical firms, imaging centers, labs, etc) have given them. They accepted what they got, may have grumbled a lot but went on with their lives. But with the ever increasing costs for healthcare services and the increasing shift of costs to individuals, people need to adopt a consumer mindset. Information empowers and emboldens. Look what the Internet has done for automobile, airline, hotel and entertainment consumers. Of course, people showing up at the ER with appendicitis, pancreatitis, or gall stones – and victims of traumatic injuries – are not going to be shopping around and will largely take what they can get. (i.e. be at the mercy of their local healthcare delivery system) but that's no reason to continue as we've been going with our healthcare purchases.

Too many people for too long a time have made little, if any, effort to participate in their healthcare decisions, opportunities and care. Providers and payers offered little helpful information; indeed they seemed to make what little information they did provide unduly complex and hard for the common person to understand. Hell, I’ve been in claims administration for 20+ years and sometimes still struggle to understand what certain providers and payers are giving to me. 

Information Empowers and Emboldens – Effects Change

I appreciate that the “non-shopper” category can account for a majority of healthcare expenses in the U.S. But why shouldn’t those using non-emergent, non-critical services be consumers? We need to start somewhere. I don’t think we need to sway the non-shoppers as much as we have to sway the system. I suspect once healthcare consumerism become more widespread and supported by tools that innovative companies like HealthSparq, PokitDok, and Castlight Health provide, that a more empowered and embolden consumer will begin to demand change from the acute, emergent and critical care service sectors. So Ken and I agree that empowerment is a key aspect we need to advance.


One last point, and I suspect this won’t endear me to my social media friend Ken Congdon and others is that I would argue that individuals, collectively and individually, need to do what’s best for themselves the patient. But true change must start with the individual. Not from someone else. Not from the Government. Not from the elites that know what's best for you. Programs exist and can be implemented to help those that truly, honestly can't help themselves. But I argue that an organic, grass roots approach to changing the American healthcare delivery system will be more easily accepted and longer lasting than one imposed by government mandate and more regulations. As peoples health literacy increases and individuals have access to better and more complete information, the opportunities for change – whether voluntary, forced by a collective group of activist individuals or imposed by voters via regulation – will effect the positive change we all know is needed in the U.S. healthcare delivery system. Empowerment indeed.

1 comment:

  1. Hey Steve,

    I really enjoyed your article. However, I'd position it more as a companion piece than a rebuttal to my op-ed. I think many folks that read my article are viewing it as an "anti-consumerism" piece. I can see why, given the title and that it focuses on the problems I see with the free market model in healthcare. However, the fact is, I think you and I are very much on the same page. I see vast potential for consumerism in healthcare. In fact, I think it is largely inevitable given the rise of HDHCPs. I feel patients need to be empowered and take more control over their healthcare decisions. I'm a huge proponent of telehealth, open data, and other technological movements that support more individual choice in healthcare. My article was basically a response to those at WHCC that seemed to believe that a free market system alone was the answer to the U.S. healthcare systems' woes. I believe consumerism will be a big part of the solution, but I don't feel it's enough to fix our broken system on its own. As I mentioned in my article, I feel the healthcare puzzle in the U.S. is complex and that it requires a 'hybrid' solution. I get very uncomfortable when "leaders" in the healthcare industry start painting with broad strokes. Nothing's ever black and white (particularly in healthcare). There are several shades of grey. My article simply introduced some of the major problems I believe would still remain in a free market healthcare system. This problem list would likely be just as long (if not longer) if I examined the problems I see with a single payer healthcare system (i.e. the antithesis of a 100% free market system). In any case, I'm glad my article prompted you to express your own views on the subject on your blog. As I said, I think we largely see eye-to-eye on the matter, with perhaps a few key differences of opinion.



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