March 20, 2019

The current trend within the healthcare sector to think of patients as consumers or customers could have potentially harmful consequences for patients, according to healthcare policy experts writing in the March issue of Health Affairs.

The article cautions against the growing tendency across the industry to conflate the concepts of “patient-centered healthcare” and “consumer-driven healthcare.”

Unlike patient-centered care, which includes efforts by providers to make their care delivery system more efficient and easier for patients to navigate, consumer-driven healthcare is “based on critical myths about what creates, and what can rein in, high-cost care,” write Michael K. Gusmano, PhD, of Rutgers University and colleagues from the Hastings Center and Harvard Medical School.  Moreover, the consumer concept “can easily place the burden for system-wide cost containment on the shoulders of individual patients.”

Efforts among healthcare providers to meet “consumers’” needs are evident across the sector, as hospitals and health systems jockey for position in an increasingly tough environment.  Markers of patient satisfaction through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and other measures, for example, can make or break an organization’s competitive status in a service area.

And, as we’ve discussed in previous eAlerts, the federal government has also manifested something of a patient-as-consumer mindset in its push for price transparency as a cost-containment measure, arguing that patients should be able to “shop” for healthcare services much as they do now for retail good and other services, and that this “comparison shopping” will empower patients and drive down costs.

But thinking of patients as consumers “wrongly assumes that healthcare is a market in the usual understanding of that term . . . and that price transparency and competition can deliver on the promise of reducing costs or ensuring quality,” the article states.

Moreover, the consumer metaphor, the authors argue, places unfair responsibility on patients to reduce healthcare costs that “could erode professional obligations to provide appropriate and effective care.”

In an article in Medscape News, Dr. Gusmano noted that consumerism has value with respect to minor issues, such as comparing prices and choosing a provider to treat, routine carpal tunnel syndrome, for instance.  However, that scenario is vastly different from expecting patients coping with major illnesses to rein in their own medical costs, he said, which unfairly shifts “the burden that ought to be placed on systems and on institutions onto individual patients, as if individual patients’ choices are to blame as to why healthcare costs are so high in the U.S., which simply isn’t the case.”

Patient-centered care incorporates a focus on providing care that is sensitive to patients’ preferences and needs, while a consumer orientation calls on patients to become prudent purchasers of healthcare services.  “The former approach empowers patients.  The latter expects patients to solve society’s cost-containment challenges,” the authors contend.

The complete article, “Patient-Centered Care, Yes; Patients as Consumers, No,” is available here.