Consumerism: Patients Need Partners

Recent reports have been gloomy on the consumerist movement in health care.

The Center for Studying Health System Change released a report recently that indicated today’s patients still find physicians how they used to: through word of mouth and referrals from other physicians.  Patients have also used quality and price information sparingly to aid in health care decision making.

The WSJ Health Blog highlighted (another CSHSC) report that concluded the number of patients who have utilized retail clinics “turns out to be modest.”

What’s going on?  Three possibilities:

  1. Patients are still spending someone else’s money (all health care dollars flow from households, but patients never actually touch it and don’t have the ability to use the cash in another fashion, as they say: perception is reality).
  2. Resources to compare quality and price information are slim (but growing).  We don’t agree on what constitutes quality (metrics or outcomes or patient experience) or how to report price (charge or cost, discounted or not?).
  3. Trust is still a factor.  This interweb thing is still relatively new…especially to health care.  Could it be that patients still trust their personal (mostly offline) networks more than an online network (which, by the way, seems the way people will find physicians: through online networks (word of mouth) accompanied by data)?  It should also be noted that the majority of patients utilizing health care services today are older and thus, much less likely to be comfortable with depending upon online resources for decision making.

A BusinessWeek article highlights consumerist proponent Regina Herzlinger and her approach to health care reform.  The article states that Herzlinger’s ideal world would contain:

  • Consumers tailor their own health-care coverage, navigating in a national insurance market.
  • Everyone must buy insurance, and the federal government maintains strict oversight to ensure price and coverage fairness.
  • Small, disease-specific hospitals care for patients who don’t need all the services offered by medical centers.
  • A national database contains the prices and outcomes for procedures at every hospital and clinic, so consumers can make informed choices.
  • Individuals get generous tax breaks to buy their own insurance, with subsidies for those with low incomes.

Here’s the important part:

Herzlinger doesn’t want anyone but consumers managing. Only then, she says, will innovations be unleashed that improve quality. “People can choose from 240 models and makes of cars pretty intelligently,” she says. “Why do we assume they can’t do the same when it comes to their health?” She notes that her suggestions are “relatively low-cost,” which makes them even more attractive given the financial crisis.

The idea sounds good in theory (and it may prove to be the solution in action).  But, as of right now, this young movement has failed to truly take hold (young is the operant word, here).  There are likely multiple causes, but the most significant is this: health care is complicated.  That has not, and will not, change overnight.  We have normative behaviors that have been ingrained since the beginning of modern medicine and that, very basically, takes time to change.

Although somewhat controversial, programs being offered by companies like OptumHealth (a subsidiary of UnitedHealth) can act as the perfect bridge into consumer-driven health care in situations that allow for analysis and discussion.  These companies provide free assistance to patients and families when they seek treatment by helping them assess quality (there are some concerns, rightly so, that an insurance company particpating in such decision-making may have a conflict of interest).

From the Minneapolis Star Tribune:

… OptumHealth and a variety of competitors are compiling sophisticated report cards that rate hospitals and medical centers by critical measures such as staff expertise, patient mortality, outcomes and cost.

Their reach is huge and growing. OptumHealth alone serves some 40 million health plan members and managed 5,000 transplants last year. The national Blue Cross and Blue Shield Association, with a similar strategy, covers 100 million people.

Their conclusion so far: Given a choice and guided by an expert like Imig, patients generally will head for the highest-quality center, even if it turns out to be far from home, friends and family.

Talk to any physician; no one expects or wants individuals to be self-diagnosing even though information is available on every disease and treatment options.  The same goes, at least for now, for quality and cost data: patients need partners.

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.