A Contrarian’s View of Healthcare “Consumerism”

With all this happy talk about healthcare “consumerism” and the employee being responsible for his/her health, I feel compelled to address some of the “red flags” I see. 

First of all, don't you just love the terms that are created to make something unpalatable look completely palatable?   "Collateral damage"  is one of my favorites.  Bluntly, it means people that are killed accidentally because they were in the wrong place at the wrong time.

Back to "consumerism".  Before running “lemming-like” off a cliff, here are a few things to think about.  I don't hear them being talked about at any of the seminars or conferences I go to nor do they show up in most healthcare consumerism articles.  If you don’t believe me try googling “healthcare consumerism”.

If I sound cynical just understand that I’ve been “around the block” a few times and believe in the saying “what goes around, comes around”.  

The onslaught of HMO’s in the 1990’s was the first major initiative to control healthcare costs.  And if you remember they didn’t turn out so well as doctors/hospitals were paid bonuses not to refer patients to specialists unnecessarily.  And they didn't ---even when they were necessary.

Today’s consumer-driven healthcare is just another initiative trying to accomplish the same thing but with the added twist of making consumers (employees) responsible.  The main purpose is to allow employers to shift a greater portion of healthcare costs to employees.

Effort is geared towards “engaging” employees in making better choices in choosing a healthy lifestyle, accessing cost-effective preventive services, selecting evidence-based medical and pharmaceutical interventions, managing their own conditions, complying with treatment regimens, and selecting high-performing health plans, hospitals and physicians.  Whew! 

But hold on --- there are some flaws here.  Key assumptions are that the consumer knows what he needs, understands all the various options available, appreciates differences in quality, is offered these at different price levels, has bargaining power and can exercise free choice to buy or not to buy.  None of this is true.

Patients usually do not know what is wrong; they do not comprehend the diagnostic possibilities; they are not familiar with the therapeutic options, they cannot assess the quality of care needed, and they do not appreciate the numerous potential outcomes. No amount of surfing the internet, browsing the media, reading popular health books, or sharing experiences with neighbors can provide all the necessary information.

The "empowered" healthcare consumer needs transparency  but it doesn’t exist in our current healthcare system.  There is an enormous gap between consumer needs and available and accurate tools/information. Please read the article associated with this link.  It's a new way to scam the system.  And it's so sophisticated that some healthcare professionals don't catch it ---  much less consumers.

These ”minor” problems don't seem be the focus.  Instead industry, in typical fashion, has pushed forward at breakneck speed to capitalize on all the peripheral business they see that can be created. Technology leads the way.  Mobile devices and other advances in technology are changing the way patients can view and interact with the healthcare system. Look at some of the consumer-facing healthcare apps, devices and products here.   And read about Ford’s prototype car equipped with a mobile healthcare management system. 

The consumer doesn’t stand a chance.  He’s besieged on all sides --- desperately needing technical information and the time to understand and absorb it --- and all the while being inundated with tech gadgets that would be great except they're not the main problem.

The reflex to put employees in the driver’s seat too quickly can result in poorly designed delivery systems that don’t necessarily improve care or reduce costs. Companies need to take a step back and insure that in their eagerness to cut costs and “consumerize” the medical experience they don’t demand more of employees than they can deliver.  If we are to continue a for-profit healthcare system while trying to cut costs, we need to, at least, level the playing field.   

Should employees be "consumer" savvy about healthcare?  Yes, but it's going to take a while.  Meantime, if we don't make it a priority to be their advocate and help them find/understand the information they need, they're in for a rough ride.

What do you think?

Jacque Vilet, President of Vilet International, has over 20 years’ experience in Global Human Resources with major multinationals such as Intel, National Semiconductor and Seagate Technology. She has managed both local/ in-country national and expatriate programs and has been an expat twice during her career.   Her true love is working with local national issues.  Jacque has the following certifications:  CCP, GPHR, HCS and SWP as well as a B.S. and M.S in Psychology and an MBA.    She belongs to SHRM, Human Capital Institute and World at Work.   Jacque has been a speaker in the U.S., Asia and Europe, and is a regular contributor to various HR and talent management publications. 

 

Comments

[Joe]

I've often ranted about this, but not in these terms or as well thought out. Well said.

And if you don't want to sound cynical, please stop putting everything in quotes.

[Jacque Vilet]

Thanks Joe. I had to laugh ---- yes I tend to overdo quotes. I'll limit them in the future!

[Tony Bergmann-Porter]

"Effort is geared towards “engaging” employees in making better choices in choosing a healthy lifestyle, accessing cost-effective preventive services, selecting evidence-based medical and pharmaceutical interventions, managing their own conditions, complying with treatment regimens, and selecting high-performing health plans, hospitals and physicians."

With the possible exception of selecting evidence based interventions, none of these things seem to me to be in any way beyond the abilities of the average adult, nor would they be affected by by any variation in the health care regime.

Of course, under a universal government-run program of health care delivery, there would be no need to select a high performing health plan, hospital or physician, since you simply get whatever is available when you reach the head of the queue.

[Trevor Norcross]

Hi Tony,
I’m not sure how you are defining the “average adult” but if they have the ability why are they not doing it? We need more education and transparency as a start. Wouldn’t it be great to have an app that compared the average cost and outcomes for different medical services? We need as much money advertising healthy food and lifestyle choices as we do McDonald’s and Burger King. It’s hard to believe we have McDonald’s and Coke as a sponsors for the Olympics. The “average” marketing department is far more sophisticated then the “average” adult.

[Tony Bergmann-Porter]

Trevor: I understand perfectly well that "data" is not the plural of "anecdote".

Having said that, I have spent most of my professional life around working class people, and not one that I ever met was incapable of grasping concepts like "watch your diet", "get exercise", "take your all of your meds", and so forth.

If people choose not to do these things, the health care delivery regime won't matter.

[Jacque Vilet]

I agree Tony that people can understand "watch your diet", "get exercise", "take your meds". But this is only the tip of the transparency iceberg. For people to take more ownership in their healthcare, they will need to understand much more than that. And healthcare information transparency is the answer.