A debate has erupted over who has — and who should have — the power to shape healthcare services. Patients, who are operating as consumers in a free market? Or physicians, who have years of specialized education and experience?
By Jennifer Girka, Healthcare Strategist, Dell EMC
Physician and futurist Eric Topol calls it a “Gutenberg moment.” In his book, The Patient Will See You Now, Topol argues just as the printing press transformed society by expanding literacy and learning beyond a small elite, today’s smartphones and social networks are changing the relationship between healthcare providers and patients.
Topol is not the first, or only, observer to predict trends in healthcare consumerization will put patients in the driver’s seat. Many see the web-driven democratization of medical information and price transparency turning patients into informed consumers who will drive down cost and drive up quality in healthcare — just as they have in other industries.
Challenge To The Medical Profession?
Not everyone agrees with this prediction. Many note that, short of attending medical school and delivering care, a patient’s knowledge is, and always will be, limited. Medical decisions are different than other consumer purchases — and the consequences greater. Relying on patients to shop for the best medical care in a free market is fraught with risks, for both the individual and society overall.
Many also cite the “80/20 rule in healthcare” wherein approximately 20 percent of patients account for approximately 80 percent of all healthcare costs. Is it likely these patients, suffering from serious diseases or multiple chronic conditions, will shop around for care? Even healthy patients are disinclined to compare options when ill or injured. One must also take into account that, according to a Health Care Cost Institute (HCCI) study, a mere 7 percent of healthcare services (e.g., cosmetic, outpatient and elective procedures) are shoppable and, in many places, consolidation of hospitals into large health systems, declining private practices, and/or a growing scarcity of physicians severely limit meaningful competition and choice.
A notable fear is patients can be easily manipulated or come to the wrong conclusion.
One experiment in patient consumer behavior has been underway since 1997, when the U.S. joined New Zealand as the only other country in the world to allow direct-to-consumer pharmaceutical advertising.
Proponents say the advertising provides consumers with useful information, encourages discussions with healthcare professionals about conditions that might otherwise not be addressed, and helps remove the stigma surrounding some diseases. Opponents say the ads do not provide enough information about actual effectiveness and downplay risks. In one study, 43 percent of respondents said they thought only “completely safe” drugs were allowed to be advertised.
In late 2015, noting that spending had increased by 30 percent in just two years to reach $4.5 billion, the American Medical Association (AMA) voted to call for a ban on direct to consumer advertising. Physicians cited concerns that ads inflate the demand for drugs, promote more expensive brand-name drugs, and contribute to rising drug prices. A Responsibility in Drug Advertising bill introduced into Congress last year proposes a three-year moratorium on direct-to-consumer advertising for new drugs.
At the same time, a number of states are moving ahead on direct-to-patient lab testing. Patients in Arizona can now order many of their own lab tests–and receive results–directly, without a physician. Concerns have been raised about the ability of patients to interpret results but others say individuals should have the right to order and review their own tests. Better result presentation, public education, and/or counseling services can help with interpretation, they say, while freeing physicians to focus on more acute care.
An Industry In Flux
Uncertainties in the current administration with respect to health coverage leaves the debate wide open. Where will the needle fall in terms of dealing with increasing healthcare costs and high-deductible health plans? The current climate on the one hand is tending to make patients more cost-conscious, motivating them to shop around for the least expensive treatment options, while on the other, restrictions within plans are narrowing the options available for covered services.
Not Either/Or, But Both
What gets lost in the healthcare consumerism debate is the nuance and complexity that makes medicine as much about social relationships as it does about the science. Doctors and patients value the power of a positive and trusting relationship to heal. Empowering both with integrated tools for easy collaboration, data-driven insight and personalized care is the key to a richer, quality of life for healthcare consumers alike and the foundation for better decisions about care. And this is something both sides need to keep in mind.