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The emergence of the new health care consumer - Part 1: Health Care Futures - Panel Discussion

Physician Executive, May-June, 1998 by Robert P. Carlson

IT USED TO BE THAT IF YOU WERE ON THE RECEIVING end of medicine, you were known as the patient. Today, medicine has metamorphosed into health care, doctors are providers, and patients are routinely being referred to as consumers of health and health care services. In Part 1 of this second annual panel discussion, six experts examine the new health care consumer.

The idea of the consumer, a concept as American as apple pie, still makes people uneasy when it's applied to health care, as you'll discover in the following discussion. Partly, it's because the relationships in the health care sector are nowhere near as transparent as they are in, say, the retail sector. In our health care system, the individual consumer is not necessarily the payer, and choice is often restricted.

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An employer funding most, if not all of the employees, health insurance premiums, as well as an increasing menu of preventive care options, may feel entitled to think of the company as a consumer of health care services. Some employers are beginning to look for tangible evidence that their health care expenditures are also good for the bottom line. They want to be able to measure the return on their investment in healthy employees. Two corporate health care directors on the panel talk about this emerging trend and why it may take a while to make the connection between employee health status and productivity.

Whether you prefer consumer, customer, purchaser, end user, ultimate buyer, or beneficiary, one thing's for sure. Many of us are as different from the bygone patient as an HMO is from the general practitioner who came to our house when we had the chicken pox. One of the reasons for many Americans' new interest, knowledge, attitudes, and expectations about health and health care is the Internet, the second topic in this discussion.

The connection between the Internet and the emerging breed of health care consumer may be hard to quantify, but according to this panel, the anecdotal evidence is clear. Unfortunately many physicians aren't ready to use this new tool or to deal with health care consumers who do.

Whether it's meeting the needs of a new generation or exploiting the potential of the Internet for health and health care, the physician executives who will be leading the American health care system have their work cut out for them.

The Physician Executive:

Who is the consumer?

Larkin: I think the consumer is the purchaser of the health benefit, which then makes the payer. which is most often the federal government or the employer, the consumer.

Reinhardt: I've always been uncomfortable with this term. To my mind, consumers are healthy people and patients are sick people, and there's a real difference. If you've got somebody In a coma, it seems a little odd to think of that person as consuming health care, as if that person were a fully informed purchaser of a commodity.

Larkin: Isn't there a spectrum of health services being delivered, because preventive health care is delivered to the otherwise perceived healthy patient?

Reinhardt: Yes, then they are a consumer. Parents who purchase well-baby care or preventive care, or even sort of worried well care. You're a consumer when you have some discretion. But when you're lying there in bed very, very sick, it isn't quite clear where consumerism ends and where you begin to be an infantilized recipient of a service rendered by people to whom you have lost control.

LeTourneau: I'm not really sure that I follow that line of reasoning.

Rippen: Maybe one way to differentiate is that it could be a spectrum. It depends on if you're applying the economic model in the sense of a consumer has choices, whereas if you'll pay anything because it's an emergency and you have to be treated right away, it becomes a different issue.

LeTourneau: But you still make a choice, even if it's an emergency. You choose to be treated or not, you choose which ER you're going to go to, you have some choice as to which physician you see. If you don't like this one you can ask for that one. I mean, you do have choices, even if you decide not to exercise them.

Holt: I think it's important to separate the purchaser, be it the employer or the federal government, from the consumer. I think most of the confusion arises over that distinction. But there's clearly a spectrum of health care consumers, and if someone is admitted to the ER, I don't know that you can call them an active, choice-enabled consumer.

The Physician Executive: If we follow this line of reasoning, then a person's status as a health care consumer decreases as his or her discretion decreases. So if someone is unconscious in a hospital, does that mean he or she is no longer a consumer of health care services?

LeTourneau: That's the thing that I don't get either--the whole concept of choice. I don't know where that ever came from. I've never heard that applied to the consumer. That's like saying that the baby that drinks the formula the mother gives it is not a consumer of the formula. It's hungry and it has no choice but to take what the mother gives it, but it certainly is the consumer of the formula, while the mother is not.

Health Care Industry

The emergence of the new health care consumer - Part 1: Health Care Futures - Panel Discussion

Physician Executive, May-June, 1998 by Robert P. Carlson

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