In: Researching the consumerist movement

Freakonomics reports on a working paper titled “Demanding Customers: Consumerist Patients and Quality of Care” by Hai Fang, Nolan H. Miller, John A. Rizzo, and Richard J. Zeckhauser by asking:

But surely it’s in everyone’s best interest for patients to stay informed, right? For patients to do their own research, to ask lots of questions — especially of their own doctors — and so forth, right? Right?

From the paper:

Consumerism arises when patients acquire and use medical information from sources apart from their physicians, such as the Internet and direct-to-patient advertising. Consumerism has been hailed as a means of improving quality. This need not be the result. Consumerist patients place additional demands on their doctors’ time, thus imposing a negative externality on other patients.

Hmm.  I don’t see the informed patient caring much about additional demands on doctors’ time.  I also don’t see patients asking fewer questions in order to speed more people through the system.  The reality of health care today is that it is a partnership.  It may not be the most efficient model, but it is one with which many are growing more comfortable.

Health care (individual) solution

From Marketplace:

Half our health care costs would disappear, Feinberg insists, if we stopped smoking, ate less, exercised more and consumed less drugs and alcohol.

I wish the money side of this problem was this easy to solve.  Whatever our solution to health care may be, a very big part of it will include personal responsibility to lead healthier lives.  Incentivizing patients to make better decisions will help.

Stories tell the story

Personal stories are powerful.  They’re also anecdotal.  While the real numbers of our health care situation are staggering (number of uninsured, underinsured, costs, etc.), they rarely tell any kind of story.

The Duluth News Tribune ran a series of stories on Sunday covering battles with poverty stemming from medical debt.  Opinions on the situations depicted in the stories will vary but the reality remains that we have significant issues to deal with—a difficult economic environment only makes this harder.  It’s startling to imagine just how many people are within a job loss or medical disaster from experiencing these same issues.

One | Two | Three | Four | Five | Six | Seven

34. Nice comes standard

Have you ever had an unpleasant customer service experience in a health care setting?  Not saying it happens everywhere or every time but such an experience has been known to occur.  All too often at some organizations.

Seth wants to know the price of nice:

So, here’s the question: if all I want, the only extra, is for someone to be nice to me when I visit your business, how much extra does that cost? How much extra to talk to a nice person when I call tech support? How much extra to find a nice receptionist at the doctor’s office? Would you pay $9 extra for a smile when you dealt with the Social Security bureaucrats and were filing a form?

The occurrence of unkindness is inexcusable, really.  No one (at least the sane no ones) expects anybody to go above and beyond in every service opportunity.  But patients should insist upon a pleasant interaction every time; a smile would be a good touch, too.

Some patients are willing to pay extra for it, they shouldn’t have to, but they are.  Insurance complicates (per usual) this thought in the health care world, but think of it like this: would you be willing to drop a five-dollar bill in a collection plate as you enter the organization’s door in order to be treated nicely throughout your visit?  Many would.  It may be surprising what people would be willing to pay for enjoyable service.

Seth finishes:

I think there’s a huge gap between what people are willing to pay for nice (a lot) and what it would cost businesses to deliver it (almost nothing). Smells like an opportunity.

Principle #34: An opportunity it is.  At our own system nice comes standard.  It’s not even (entirely) about the financial opportunity that comes with being nice, it’s (mostly) about the way people should be treated in their time of need.  We will include “will be nice to everyone” in the first paragraph of the job description.

They’ll fight your health care fight for you

Read this article in The Wall Street Journal about fighting health insurers when they deny coverage.  It’s tough:

In any case, appealing an insurer’s decision is often complex and tricky, and the deck can seem stacked against you. It is often hard for consumers to know what is covered and what isn’t in an insurance plan. Indeed, insurers have been winning a majority of the cases reviewed by state regulators in recent years, with victories for insurers at 59% in 2006.

Here is what you need to know: get help.

The WSJ article provides several examples of patients doing just that.

Another option: get help from the start.  Today’s health care world almost necessitates it.

Health advocates are the answer.  From Marketplace:

Navigating that system — and, increasingly, fighting it — can be expensive. With coverage shrinking, people are looking for help in dealing with the details. There are doctors’ appointments to book, insurance companies to pay, medications to monitor. But there are companies that’ll shoulder that burden for you. For a price, of course.

The story highlights health advocate company Guardian Nurses.

Here’s what such a company can do for the patient:

Health advocacy companies make up a tiny fraction of the health-care field. But experts say the market is growing as people feel squeezed between full-time work and full-time management of their family’s health care. Advocates can search for specialists, book doctors appointments, and keep track of medications. They’ll also manage electronic health records, and provide a second set of ears during a consultation.

On a side note, according to the article, there is only one college that offers a health advocacy degree.  Not that a specific degree is necessary to perform the functions of a health care advocate, expect more universities to offer similar programs.

Stick Compliance

Arrowsight Medical is starting to install video cameras at hospital handwashing stations in order to monitor (read: increase the frequency of) the practice.  It’s been well covered here, here, and here.

How about this: if hospitals were truly serious about 100% compliance, why not fire employees/strip privlages for those who choose/”forget” to wash their hands?

Really, just asking.

The Reverberations

Financial news writers have borrowed from the world of medicine in explaining last week’s financial fallout.  Turns out, the fallout from last week will likely have long-lasting health care policy implications, too.

An excerpt from The Health Care Blog: “the bailout will use up the fiscal margin for any subsidized solution to health reform. There will simply be no extra dollars in the federal budget for the uninsured for many years.”

Update: Here’s some more and why.

Health care demanded

Some companies are starting on-site medical clinics in an effort to combat constantly rising health care costs.  The Pioneer Press reports on a St. Paul-area company’s decision to do just that.

Here is the truly interesting take away from the story:

The manufacturer opened an on-site clinic Wednesday that will provide free primary care to its 450 workers and their families. Two workers showed up right away, and one with pneumonia sought care during Thursday’s ribbon-cutting. (emphasis added)

During the ribbon cutting! Is this an indication of the state of health care?  Where people forgo necessary treatment until an affordable option presents itself?

Apparently so.  And it’s not good.

Back in Ohio (and real life)

I was met with some interesting poll results as I arrived back in the political hotbed of Ohio.

The Columbus Dispatch conducted a recent poll that found:

Fifty-six percent in a Dispatch Poll say expanded health care accompanied by higher taxes is preferable to lower taxes with fewer people covered.

That’s intriguing because another recent poll has John McCain leading Barack Obama—the candidate most likely to introduce more government intervention into health care.

That same poll concluded this: “On health care, 65 percent of respondents said they support providing it for all Americans, even if it means raising taxes.”

It’s more evidence that health care continues to fall in issues of priority in this election.