Wednesday, March 10, 2010

Patients Versus Consumers

There's going to be a lot of talk about health care in the next few weeks. On the federal level, the Democrats are claiming that health care legislation is not dead and that something will pass soon. Although, one should note that the rhetoric has changed to "insurance reform" from health care reform. That by itself is not good news. People need health care, not necessarily health insurance. Insurance is simply the paying vehicle. We could have a public non-profit as the paying vehicle which would simplify and cost contain at the same time. Politically, that will not happen. On the state level health benefits will be under scrutiny because of both continued health care inflation and because of another year of low revenues for the State's General Fund.

One perspective that deserves attention is the concept of "consumer driven health care". This idea of the patient as consumer is popular now in health care policy discussions. The idea is an attempt to understand how health care functions and well intentioned, but I believe flawed.

Let us play out the analogy between health care consumer versus patient. First, when I set out to buy a consumer item there is always the question of "is this a need or want?" I do not believe that is the case with health care, and I find the beliefs around this issue fascinating. I believe that the overwhelming majority of people go to the doctor when they perceive a legitimate need to go. What fascinates me is that everybody believes everybody else is a hypochondriac! Moreover, this idea that we go to the doctor too much is a 180 degree turnaround from what the health care industry was telling us in the 1980s. At that time Health Maintenance Organizations (HMO) were the rage. The idea was for people to maintain their health with regular doctor visits rather than waiting for acute symptoms. Every time one challenges the concept of overuse of health care the response back is purely anecdotal and usually absurd; such as someone going to the emergency room with a cold. How much does that really happen? Do you Mr/Ms Reader go to the doctor on a whim? Do you like missing work and sitting around in waiting rooms reading year old magazines?

Second, when I buy a consumer item all sorts of retailers are competing on the basis of price. What health care facilities compete on price? Have you ever seen a hospital run a commercial advertising discount surgeries for the month of April? No, and you never will. Hospitals and other health services compete on the basis of quality. "We have the best doctors. We have the newest MRI. We have birthing suites."

Third, when I buy a consumer item it is between the sales person and me. If I have done a little research on the internet, I probably know as much as the retail sales person about the product and what I need. A patient always has experts (doctor, specialist, etc.) telling him/her what is needed, how much is needed, when and where to get it. Moreover, the patient is not qualified to argue about it. Is it really appropriate for a patient to say "No, Doc I only need a double bypass, not the more expensive triple"? Should a patient say "No, Doc, not twice a day, I'm trying to save, let's say once a day"? Or perhaps the patient in the back of the ambulance should say "Wait fellas don't take me to General Hospital, it may be closer, but St. John's has a better room rate".

I believe that everyone is going to have to work together for solutions to the exploding cost of health care, particularly at a time when the State is basically broke. However, I do not believe that health care functions like other commodities in the market place.

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