Should patients be considered consumers?
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.
More information: Michael K. Gusmano et al. Patient-Centered Care, Yes; Patients As Consumers, No, Health Affairs (2019). DOI: 10.1377/hlthaff.2018.05019