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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Reinhardt: The switch from patient to consumer in our health policy lexicon was not just an innocent semantic difference. It changed the whole ideology of health care in the sense that it legitimized the market and health rationing by income, all the things that come with the notion of a consumer. On the one hand, you can say that anyone who stuffs something into their mouth is a consumer, but that doesn't bring with it an ideology. In my discipline of economics, it increasingly suggests that consuming health care is just like consuming bread, and that it's perfectly all right to tier the health care experience by income class just as we tier the food experience by income class. I'm not suggesting we shouldn't have that, but you should call things honestly what they are.

LeTourneau: Uwe, I couldn't agree with you more. I think that the use of the term consumer makes a business out of health care, whereas the term patient goes to the heart of medicine, which is that you take care of people. Part of the problem is the divergence between those two aspects of health care, and the terms consumer and customer certainly relate to the business aspect.

Larkin: Changing from patient to consumer also implies somewhat of an Intention to take the individual out of the dependent role of a patient and put them in the more responsible role of consumer.

Reinhardt: That does go with it and may be a positive aspect of it.

Holt: Uwe is quite right in saying that this is extremely tier-based, for example, based on income, especially in the U.S., but also in other countries. If you look at the emergence of what the Institute for the Future calls the new consumer, you're talking about a lot of people, but it's clearly the upper echelon, better educated, more affluent...

Reinhardt: Internet-connected...

Holt: ...Internet-based consumers, who make up about 45 percent of people in the U.S., but it clearly leaves out a lot of people who are still patients.

Weatherup: I think that there are simultaneous roles of both patient and consumer. Unfortunately, there are very few people that actually play the consumer role, which implies some financial responsibility.

Reinhardt: That's true. Recently, I was asked to talk about that, and I gave the talk the title, "Whom Do You Have to Please in Health Care to be a Winner?" That, of course, depends on who you are. If you are a health plan, I identified five markets that you have to please, but the most important one, obviously, is the benefit managers. You've got to please them because if you don't, they might not list you on the menu of plans presented to employees. If you really tick off benefit managers. they might even treat you as business treated the HMOs in Minnesota: They might bypass you completely.

When it comes to the sort of backwater and 18th Century health insurance systems like we have in New York and New Jersey, they don't really give much of a damn about the people who actually buy their product. They deal with the health benefit managers. Half of these plans don't have a Web site that prospective enrollees could surf. If you want to know where a doctor trained, they won't tell you that. These plans have not yet recognized that the ultimate buyers of insurance are people like me and that we are worth worrying about. But I think in the next 10 years they will learn the hard way that they have to be more respectful of consumers, the ultimate purchasers of their insurance products.