In an attempt to improve health outcomes and create more patient-centered health care systems, the concept of patient-centered care has increasingly merged with the metaphor of patients as consumers. This is something which, according to Michael K. Gusmano and Karen J. Maschke, two Hastings Center research scholars, and Hasting Center President, Mildred Z. Solomon, “is conceptually confused and potentially harmful.”
In an article published by Health Affairs titled, “Patient-centered care, yes; patients as consumers, no,” the authors detail why the consumer metaphor “wrongly assumes that health care is a market in the usual understanding of that term.” A recent press release summarizes the article, sharing four reasons why the metaphor is inappropriate:
- Health care is not a market.
- The high cost of health care is not due to excessive “consumer” demand.
- Price transparency won’t lower costs, either.
- The consumer metaphor could erode physicians’ professionalism.
According to the press release, this argument against patients as consumers is being adopted by advocates of market solutions to health care costs as well as critics of government health care regulation.
Health care vs. conventional consumer markets
The authors believe it is a disservice to patients (and the industry at large) to consider them consumers. To better understand the disparities between patients and consumers, the authors dig into the differences between the health care system and typical consumer markets. One example the authors look at is the cost structure. In health care, the cost structure is not driven by consumer demand in the same way it is in a traditional consumer market.
“Even if health care were to be made more like a conventional market – for example, by increasing the number of competitive health care choices – patients still could not act like consumers because they would often lack the time and knowledge to ‘shop’ for different options.”
According to the authors, health care prices increase when physicians are compensated based on each services they provide “and the U.S. government’s failure to sufficiently negotiate prices of hospital, physician and other health care services.”
Along the same lines, the article looks at why price transparency is also not a driver of costs. While being transparent is helpful, there is no evidence that it reduces health care spending (like it generally would in a typical consumer market). According to the press release, the authors believe this to be caused by time constraints that are naturally prevalent for patients seeking care, as well as a lack of “knowledge to shop around for health care options that provide treatments at the best value.”
Finally, the authors argue that the idea that the “consumer is always right” does not translate well into a health care setting. In fact, following this principle may “erode medical professionalism and could result in poorer patient outcomes.”
Unnecessary burdens
Given the role marketing research plays within the health care industry, this dispute is one to pay close attention to. Summing up their findings on the patient as consumer comparison, the authors write, “Pursuing the sensible goal of creating a patient-centered health system will be undermined if consumer metaphors prevail.” So, how do we advocate for patient-centered care without burdening patients or eroding medical professionalism? For MR, this article certainly provides food for thought.