Consumerism in healthcare is best defined as individuals proactively using reliable, relevant information and appropriate technology to make better-informed decisions about their broader healthcare options, both internally only outside the clinical setting.1
Healthcare consumerism recognizes the importance of a patient or family member in the continuum of the healthcare journey. As what becomes important to the patient becomes more apparent, the concept continues to evolve.
The origins of consumerism can be traced to the push for health insurance in the 1930s, with the patient having a say in how their care would be paid for. The protest against the provision of care to people living with HIV/AIDS in the 1980s showed that it is the patients, not the government or the payers, who must determine how health care is delivered to a population. .2
This article examines what drives today’s consumerist movement and explores the evolution of health care delivery and the health care system as a platform for a practice to thrive. No discussion of healthcare consumerism would be complete without addressing legitimate concerns about the use of the term, both perhaps marginalizing the concept of patient as well as placing the burden of health system shortcomings on the patient rather than the system.
What is driving healthcare consumerism today?
A consumer-driven system must consider cost and experience.3 When systems, practices or individual providers attempt to respond to what is important to the patient or consumer, the fundamental assumption, however flawed, is that the quality of care will not differ from provider to provider. another and that, quality being a fixed variable, value depends mainly on costs.
Markets and consumers have always focused on the cost of goods and services in places like grocery stores and restaurants, as the responsibility for payment rests solely with the consumer.
For years, consumers of health care had little or no responsibility for payment, as generous employer or government-provided insurance products covered most of the cost of care.
As the cost of these insurance programs has become unsustainable, the cost of care has shifted to the patient. As patients became cost-conscious, they predictably became consumers in the traditional sense.
Some consumers choose high-deductible health plans where lower premiums are offset by copayments or higher deductibles. These plans stimulate consumerism in 2 ways. Apparently, they can promote personal responsibility for care.
Making better lifestyle decisions and using preventative care would hopefully reduce not only overall healthcare costs, but out-of-pocket expenses as well. Unfortunately, this often means that overall health care spending is unchanged, but the consumer pays a greater portion of health care costs.
Data from 2018 showed that patient financial responsibility increased by 11% in 2017. The impact of this increase in spending led to more than 10% of patients struggling with this financial responsibility.3
Value-based care, the essence of consumerism, is about more than cost control. Although traditionally value has only been related to 2 variables – quality and cost – the definition of value is now consistent with that of the Institute for
Triple objective of improving health care. This improves health while reducing the cost per capita and also enhances the patient experience.4 The Washington Health Alliance defines the element of patient experience at every stage of the healthcare journey, from insurance product enrollment to before, during, and after each visit.5 Value, the cornerstone of consumerism, has a different formula.
Practitioners would be well served to understand the dynamic environment of consumerism and health care at this time, as well as the anticipated changes, and how they will share responsibility and equally benefit from the changes.
Health care transformations
Although today’s healthcare system is characterized as a high-cost system with lower quality and safety performance than might be expected at the price, it has identified and acted on several opportunities both at payer and provider level.6.7
Responsibility for costs should rest with the health care system and, by proxy, with the provider. Despite introductions in payments reform, much of the nation’s health care dollar is still spent in volume rather than value. An acceleration towards value-based programs that pay either per episode (flat rate) or per population (accountable care organization) is inevitable.
Physicians will need to learn that these modern systems thrive not when an individual tries to manage the complexity of care, but when well-trained teams design programs that promote healing (surgery) as well as prevention and wellness.
For physicians to succeed in this paradigm, they must be willing to lead teams and share the risks and financial gains that would come from well-coordinated care.
Providers need to quickly embrace evidence-based care and stop relying on expensive unproven technologies. In addition to financially incentivizing evidence-based care, incentives for low-value, volume-based care must be removed.
3. New Suppliers
It is no longer enough to worry about other health care systems or practices in your market. The toughest competition will come from those who have already succeeded in a consumer-driven world, such as companies that have proven themselves easy in services driven by technology and artificial intelligence to guide effective marketing and targeting.
These strategies are not only a revenue-generating opportunity, but also a key part of disease prevention and management, especially costly chronic diseases, pushing these entities towards success in a risk-based environment.
For example, Best Buy, known to be more resilient than most retail electronics giants, is active in patient monitoring, a key part of the hospital-to-home movement which is a favorable space in terms of cost.
COVID-19 and healthcare consumerism
The COVID-19 pandemic has rapidly changed the way consumers view health and healthcare. A team from management consultancy McKinsey & Company lists 5 important areas for consumers.8
1. Meet the needs of the whole person
2. Empower consumers to make better decisions
3. Personalize and improve engagement
4. Provide a seamless customer experience across healthcare journeys
5. Integration of in-person and virtual healthcare solutions
Patients often have no choice in their current episode of care (eg, ambulance transport to the emergency department). But remember: they can have a choice in their neighbor. Consumerism should allow patients a voice in how their health care dollars are spent, but that should not be an excuse for accelerating cost shifting or shifting responsibility for lowering the cost of care to the patient. Patients deserve the same, if not more, attention that other consumers expect.
- Carman K, Lawrence W, Siegel J. The “new” healthcare consumerism. Health Affairs. March 5, 2019. Accessed February 28, 2022. https://www.healthaffairs.org/do/10.1377/forefront.20190304.69786/full/
- Wyke A. Can patients drive the future of healthcare? Harvard business review. July 1, 1997. Accessed February 28, 2022. https://hbr.org/1997/07/can-patients-drive-the-future-of-health-care
- Heath S. Breaking the foundations of health care consumerism. Patient engagement achieved. November 24, 2020. Accessed February 28, 2022. https://patientengagementhit.com/news/breaking-down-the-basics-of-healthcare-consumerism
- The triple objective of the IHI. Institute for Health Care Improvement. Accessed February 28, 2022. http://www.ihi.org:80/Engage/Initiatives/TripleAim/Pages/default.aspx
- Get the high-value care you deserve. Washington Health Alliance. Accessed February 28, 2022. https://wahealthalliance.org/getting-the-high-value-care-you-deserve/
- Mirror, mirror 2021: A reflection of poor health care in the United States compared to other high-income countries. The Commonwealth Fund. August 3, 2021. Accessed February 28, 2022. https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly
- Zimlichman E, Nicklin W, Aggarwal R, Bates DW. Health 2030: the transformation ahead. NEJM catalyst. March 3, 2021. Accessed February 28, 2022. https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0569
- Cordina J, Levin E, Ramish A, Seshan N. How COVID-19 has changed the way consumers perceive healthcare. McKinsey and company. June 4, 2021. Accessed February 28, 2022. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/how-covid-19-has-changed-the-way-us-consumers-think-about-healthcare