Nav: Home

Should patients be considered consumers?

March 04, 2019

There is broad support for building health care systems that are patient centered, seen as a means of improving health outcomes and as morally worthy in itself. But the concept of patient-centered care has increasingly merged with the concept of patients as consumers, which "is conceptually confused and potentially harmful," write Michael K. Gusmano, a Hastings Center research scholar and an associate professor at Rutgers University; Karen J. Maschke, a Hastings Center research scholar; and Hastings Center president Mildred Z. Solomon in an article in the March 2019 issue of Health Affairs.

The metaphor of patients as consumers, long used by advocates of patient-centered care, has recently been co-opted by critics of government health care regulation and advocates of market solutions to health care costs. Gusmano, Maschke, and Solomon discuss why the consumer metaphor is inappropriate.

Health Care is not a Market

Patients can be construed as consumers only if they are operating within a market. But there are several key differences between health care and typical commercial markets. Patients often lack the information and time to select the best health care on the basis of quality and price. 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.

The High Cost of Health Care is not Due to Excessive "Consumer" Demand

Some commentators believe that health care costs are high because patients overuse health care, and that one way to reduce costs is to make patients pay more out of pocket. Though requiring patients to pay more for their care has been shown to reduce overall health care spending, this tactic also reduces patient usage of appropriate or essential medical care. What does drive up health care costs, the authors write, is the common practice of compensating physicians for each service they provide and the U.S. government's failure to sufficiently negotiate prices of hospital, physician, and other health care services.

Price Transparency Won't Lower Costs, Either

In conventional markets, knowing the price of different items might help customers make informed choices about what to purchase. While it is helpful for patients to consider the costs of different treatments as part of deciding the best course of action with their provider, there is little evidence that price transparency reduces health care spending. Patients may have little time or insufficient knowledge to shop around for health care options that provide treatments at the best value.

The Consumer Metaphor Could Erode Physicians' Professionalism

Physicians rely on their knowledge, skill, and obligations to patients' well-being to recommend the best course of treatment. But if "the customer is always right," physicians might feel compelled to defer to what patients ask them to do, for example, when patients insist on unproven, ineffective, or even harmful treatments, such as cardiopulmonary resuscitation for terminally ill patients. Avoiding or devaluing physician expertise in health care decision-making would erode medical professionalism and could result in poorer patient outcomes.

The concept of patients as consumers does not bolster patient-centered care but instead places undue burdens on patients to reduce health care costs and erodes medical professionalism, the authors write. "Pursuing the sensible goal of creating a patient-centered health system will be undermined if consumer metaphors prevail," they conclude.
-end-
To interview Michael K. Gusmano, Karen J. Maschke, or Mildred Z. Solomon, contact:

Susan Gilbert
Director of Communications
The Hastings Center
gilberts@thehastingscenter.org
845-424-4040 x 244

The Hastings Center

Related Health Care Articles:

Large federal program aimed at providing better health care underfunds primary care
Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the US receive treatment.
International medical graduates care for Medicare patients with greater health care needs
A study by a Massachusetts General Hospital research team indicates that internal medicine physicians who are graduates of medical schools outside the US care for Medicare patients with more complex medical needs than those cared for by graduates of American medical schools.
The Lancet Global Health: Improved access to care not sufficient to improve health, as epidemic of poor quality care revealed
Of the 8.6 million deaths from conditions treatable by health care, poor-quality care is responsible for an estimated 5 million deaths per year -- more than deaths due to insufficient access to care (3.6 million) .
Under Affordable Care Act, Americans have had more preventive care for heart health
By reducing out-of-pocket costs for preventive treatment, the Affordable Care Act appears to have encouraged more people to have health screenings related to their cardiovascular health.
High-deductible health care plans curb both cost and usage, including preventive care
A team of researchers based at IUPUI has conducted the first systematic review of studies examining the relationship between high-deductible health care plans and the use of health care services.
Health insurance changes, access to care by patients' mental health status
A research letter published by JAMA Psychiatry examined access to care before the Patient Protection and Affordable Care Act (ACA) and after the ACA for patients grouped by mental health status using a scale to assess mental illness in epidemiologic studies.
Medical expenditures rise in most categories except primary care physicians and home health care
This article was published in the July/August 2017 issue of Annals of Family Medicine research journal.
Care management program reduced health care costs in Partners Pioneer ACO
Pesearchers at Partners HealthCare published a study showing that Partners Pioneer ACO not only reduces spending growth, but does this by reducing avoidable hospitalizations for patients with elevated but modifiable risks.
Health care leaders predict patients will lose under President Trump's health care plans
According to a newly released NEJM Catalyst Insights Report, health care executives and industry insiders expect patients -- more than any other stakeholder -- to be the big losers of any comprehensive health care plan from the Trump administration.
The Lancet: The weaponisation of health care: Using people's need for health care as a weapon of war over six years of Syrian conflict
Marking six years since the start of the Syrian conflict (15 March), a study in The Lancet provides new estimates for the number of medical personnel killed: 814 from March 2011 to February 2017.
More Health Care News and Health Care Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

In & Out Of Love
We think of love as a mysterious, unknowable force. Something that happens to us. But what if we could control it? This hour, TED speakers on whether we can decide to fall in — and out of — love. Guests include writer Mandy Len Catron, biological anthropologist Helen Fisher, musician Dessa, One Love CEO Katie Hood, and psychologist Guy Winch.
Now Playing: Science for the People

#541 Wayfinding
These days when we want to know where we are or how to get where we want to go, most of us will pull out a smart phone with a built-in GPS and map app. Some of us old timers might still use an old school paper map from time to time. But we didn't always used to lean so heavily on maps and technology, and in some remote places of the world some people still navigate and wayfind their way without the aid of these tools... and in some cases do better without them. This week, host Rachelle Saunders...
Now Playing: Radiolab

Dolly Parton's America: Neon Moss
Today on Radiolab, we're bringing you the fourth episode of Jad's special series, Dolly Parton's America. In this episode, Jad goes back up the mountain to visit Dolly's actual Tennessee mountain home, where she tells stories about her first trips out of the holler. Back on the mountaintop, standing under the rain by the Little Pigeon River, the trip triggers memories of Jad's first visit to his father's childhood home, and opens the gateway to dizzying stories of music and migration. Support Radiolab today at Radiolab.org/donate.