Researchers from the Hastings Center argue consumerism in healthcare is undermining patient-centered care by placing undue burdens on patients to reduce costs.
The customer is always right in in most industries. But industry experts from the Hastings Center are saying the maxim does not and should not apply to providers despite the consumerism in healthcare trend.
In fact, regarding patients as consumers could undermine industry efforts to advance patient-centered care, wrote Michael K. Gusmano, Hastings Center Research Scholar and Associate Professor at Rutgers University, Karen J. Maschke, Hastings Center Research Scholar, and Mildred Z. Solomon, Hastings Center President in a recent Health Affairs article.
“Pursuing the sensible goal of creating a patient-centered health system will be undermined if consumer metaphors prevail,” they wrote. “Patient-centered approaches aim to ensure clinical care that can meet patients’ preferences and needs. That is different from a consumer orientation calling on patients to be prudent purchasers of medical care services. The former approach empowers patients. The latter expects patients to solve society’s cost-containment challenges.”
As Gusmano et al. observed, consumerism in healthcare aims to lower costs and improve quality by empowering patients to shop around for medical services and items. The concept supports more market-based approaches to healthcare, such as health insurance exchanges and high deductible health plans.
The goals of consumerism in healthcare differ from those of patient-centered care. However, supporters of the concept have started to adopt the language of patient-centered care, Gusmano et al. pointed out.
For example, supporters of a health savings account initiative in Indiana used “patient-centered care” and “consumer-oriented care” interchangeably in a 2017 Forbes article. The interest group Americans for Prosperity also recently referred to former House Speaker Paul Ryan (R-WI)’s proposal to bolster consumer-oriented healthcare options as “patient-centered.”
Gusmano et al. described the merging of patient-centered care and consumerism in healthcare as “conceptually confused and potentially harmful.”
Referring to patients as consumers is inappropriate because healthcare is not a market, the authors elaborated. Unlike consumers in commercial markets, patients oftentimes lack the information, time, and emotional stamina to shop for the highest value healthcare based on cost and quality.
As a result, consumerism in healthcare will not effectively reduce costs, the authors added.
Healthcare spending is slated to account for over 19 percent of GDP in less than a decade. But stakeholders expect consumerism in healthcare to slow the accerlated growth of national health expenditures. Patients with higher out-of-pocket costs will limit healthcare utilization and reduce the overuse and costs of healthcare, they argue.
But overuse is not the problem behind excessive costs, Gusmano et al. contended. Decades of fee-for-service have led to higher utilization and costs, and the federal government’s inability to negotiate the prices of hospital, physician, and other healthcare services exacerbated the problem.
“The US relies on a system of uncoordinated payment by thousands of payers, many of which do not have the bargaining power necessary to drive down prices,” the article stated. “This has resulted in high prices for medical services. Technological improvements in healthcare have driven increases in cost all over the world, but extraordinarily high prices and a refusal by government to regulate them or bargain them lower differentiate the US from other countries.”
Consumerism in healthcare inappropriately puts the burden of reducing healthcare costs on the patient, which counters the idea of patient-centered care, which aims to meet patient needs and preferences.
Furthermore, consumerism in healthcare could reduce physician professionalism, resulting in less patient-centered care.
“Professional organizations resist the attitude that ‘the customer is always right.’ Such disputes can arise, for example, when terminally ill patients or their families insist on cardiopulmonary resuscitation or other treatments that their physicians believe would be harmful or ineffective,” the article stated.
“Hospitals must judge each case to find the right balance between patient and family preference and physician integrity. It seems reasonable to anticipate that as the consumer metaphor grows, physicians’ authority in these kinds of cases could erode to the point where they may become technicians doing what they are asked to do, but doing so against their own consciences.”
Gusmano et al. advised stakeholders to keep patient-centered and consumer-oriented care separate to effectively reduce costs and improve quality. They also recommended that stakeholders broaden their focus on consumerism to ensure the concept is not interchangeable with patient-centered care.
Date: March 29, 2019