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Could consumerism hurt the healthcare system and undermine patient-centric care?

The goals of consumerism and patient-centered care can be at odds, and the former may not be as effective in reducing costs as people thought.

Jeff Lagasse, Associate Editor

Hospitals and health systems are increasingly viewing patients as consumers, and it's easy to understand why: The industry itself it starting to become more consumer-centric, with providers beginning to offer some of the same amenities and conveniences found in other industries, such as retail.

But industry experts from the Hastings Center, publishing their findings in Health Affairs, said thinking of patients as consumers could have negative long-term effects on the financial health of the system.

Specifically, they said regarding patients as consumers could undermine industry efforts to advance patient-centered care. Patient-centered approaches aim for ensuring clinical care that can meet patients' preferences and needs, they said -- which is different than a consumer focus which calls on patients to be prudent purchasers of medical care.

"The former approach empowers patients," the authors wrote. "The latter expects patients to solve society's cost-containment challenges."

IMPACT

The goal of consumerism in healthcare is to lower costs and improve care quality; the theory is that if patients shop around for services they'll ultimately drive down costs. This places more emphasis on market-based approaches such as high deductible plans and health insurance exchanges.

The problem is that the goals of consumerism and patient-centered care are different, and yet the language used to describe patient-centered care and consumerism are starting to blend together, which creates conceptual confusion that could be "potentially harmful," in the authors' views.

The reason is that patients often lack the time, information and stamina to shop for the best value in healthcare, unlike consumers in commercial markets. The authors conclude that, as a result, consumerism won't be effective in reducing costs.

A common view is that consumerism will slow the accelerated growth of national health expenditures, since patients with high out-of-pocket costs will limit utilization and reduce the overuse of healthcare.

The Health Affairs study contends that overuse isn't the true culprit behind inflated costs, but instead is due to decades of a fee-for-service reimbursement structure, combined with the federal government's struggles in negotiating hospital and physician prices.

WHAT ELSE YOU SHOULD KNOW

The high costs, the authors said, are due to a system of uncoordinated payment by thousands of payers, most of whom don't have the bargaining power necessary to drive down prices.

Consumerism shifts the burden of lowering costs to the patient, which they said contradicts the ethos of patient-centered care, which is focused around needs and preferences.

The authors recommended keeping patient-centered and consumer-centered care separate to better improve quality and reduce costs, and to broaden the focus on consumerism to keep the concept from being interchangeable with patient-centered care.

THE TREND

The findings run counter to the beliefs of many, who embrace consumerism as necessary and the future of healthcare.

"Consumer centricity," as July 2018 research calls it, is required to win in today's era of active consumers. Consolidating health systems and commoditized plans and medicines means greater consumer engagement is required so that consumers select their system, their plan and their drug. And funders of healthcare are demanding greater value of systems and drug manufacturers, requiring consumer centricity to get people to change their behavior and, in turn, drive down healthcare costs.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com

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