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:

Mental health outcomes among health care workers during COVID-19 pandemic in Italy
Symptoms of posttraumatic stress disorder, depression, anxiety and insomnia among health care workers in Italy during the COVID-19 pandemic are reported in this observational study.
Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.
MU Health Care neurologist publishes guidance related to COVID-19 and stroke care
A University of Missouri Health Care neurologist has published more than 40 new recommendations for evaluating and treating stroke patients based on international research examining the link between stroke and novel coronavirus (COVID-19).
Mental health of health care workers in china in hospitals with patients with COVID-19
This survey study of almost 1,300 health care workers in China at 34 hospitals equipped with fever clinics or wards for patients with COVID-19 reports on their mental health outcomes, including symptoms of depression, anxiety, insomnia and distress.
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.
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.
More Health Care News and Health Care Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Debbie Millman: Designing Our Lives
From prehistoric cave art to today's social media feeds, to design is to be human. This hour, designer Debbie Millman guides us through a world made and remade–and helps us design our own paths.
Now Playing: Science for the People

#574 State of the Heart
This week we focus on heart disease, heart failure, what blood pressure is and why it's bad when it's high. Host Rachelle Saunders talks with physician, clinical researcher, and writer Haider Warraich about his book "State of the Heart: Exploring the History, Science, and Future of Cardiac Disease" and the ails of our hearts.
Now Playing: Radiolab

Insomnia Line
Coronasomnia is a not-so-surprising side-effect of the global pandemic. More and more of us are having trouble falling asleep. We wanted to find a way to get inside that nighttime world, to see why people are awake and what they are thinking about. So what'd Radiolab decide to do?  Open up the phone lines and talk to you. We created an insomnia hotline and on this week's experimental episode, we stayed up all night, taking hundreds of calls, spilling secrets, and at long last, watching the sunrise peek through.   This episode was produced by Lulu Miller with Rachael Cusick, Tracie Hunte, Tobin Low, Sarah Qari, Molly Webster, Pat Walters, Shima Oliaee, and Jonny Moens. Want more Radiolab in your life? Sign up for our newsletter! We share our latest favorites: articles, tv shows, funny Youtube videos, chocolate chip cookie recipes, and more. Support Radiolab by becoming a member today at Radiolab.org/donate.