Patients as Consumers: Is it a beneficial premise for all?

Patients have increasingly become consumers primarily as result of the thrust to reform the health care system into a free market, by policymakers. The premise underlying several health care reform proposals is the view that empowered people (those who seek and obtain access to information) will ensure that their money is efficiently spent and as such will change their health care consumption behavior in a way which will force providers to compete on cost and quality, thereby reducing costs. Whilst the “patient as consumer” campaign has a positive aspect in that it advocates for patients having access to information and playing a more active role in their personal medical care decisions, in my opinion, it is largely unhealthy to view the patient as a consumer.
Arguably, the more consumerist patients will be disproportionately found within the higher income and educational attainment strata, and are more likely to be the purchasers of private insurance. The insured gets care less expensively, whilst uninsured patients are relegated to a market place in which they must bargain individually with providers who are determined to recoup what they bargained away to insurers (Hall and Schneider, 2008). Consequently, persons who are poor and unable to purchase insurance are adversely affected by high health care costs. Quality health care is not even guaranteed when you are insured, because patients’ ability to choose among doctors and diagnostic tests are restricted. Many are denied coverage of the most basic preventive healthcare, such as yearly physical exams (Blumenberg, 2003).
Health care costs are driven by medically necessary procedures which are not price-responsive. For example, when a doctor tells a patient he needs chemotherapy, the decision to proceed will not be based on the cost. The costs for such treatments are so high that a consumer is unable to pay out–of-pocket and as such, are paid by some form of insurance, therefore the patient has no interest in containing costs, but in the quality of health care offered. The debilitating impact of illness diminishes information gathering and decision-making functions, which inhibit patient’s choice of providers, thereby decreasing competition and costs. Klugman (2011) argues that whilst America has the most “consumer-driven” health care system in the advanced world, it has by far the highest costs and provides a quality of care no better than far cheaper systems in other countries.
There is the counter argument that the success of modern medical treatment requires high levels of compliance by patients and that more informed patients will be better patients. However, consumerist patients who usually are more informed about their own health and medical treatments can place additional demands on doctors’ time (a scarce resource and an important input into quality of care), thereby reducing the time available to others, especially the less informed (Fang et al., 2008).
Within developing countries, the sick have been encouraged to become “consumers” by paying for health care services out-of-pocket. Agencies such as the World Bank suggested that user fees were a panacea that would generate additional funds for the health care sectors within developing countries, increase efficiency of government health services delivery by reducing frivolous demand for services and improve access to health services by the poor. However, Yates (2009) argues that user fees have been an ineffective, inefficient and inequitable financing mechanism because the poor have been disproportionately affected in terms of their reduced utilization of services and high health care expenditures. Additionally, few countries implement protective or exemption policies for low-income groups (Birn et al, 2009). In many developing countries, people do not seek care when they are sick because of high user fees and indirect costs such as transportation costs, which have combined to exclude the poor from the formal health care system. Consequently, the poor have sought care within the informal health care sector which largely operates outside the formal regulatory framework. Thus, there are major implications for patient safety (Forsberg et al., 2011).
Policies oriented towards treating patients as consumers are not guaranteed to work because of the onerous burdens placed on patients by exorbitant user fees and subsequent poor utilization of services. It has been shown that in the midst of illness, increased knowledge and access to information does little to effect reduction in skyrocketing health care costs because at this point the patient is uninterested in “shopping” comparatively. The assertion that user fees will generate additional funds and increase access to services by the poor is a fallacy and health care reform proposals which are predicated on this premise will be largely unsuccessful.
References
Birn, A.E., Pillay,Y., & Holtz, T.H. (2009). Textbook of interntional health: Global health in a Dynamic world. Oxford University Press.
Blumenberg, L. (2003). Patients as consumers and advocates. Retrieved from
http://www.thyroid.about.com
Fang, H., Miller, N., Rizzo, J.A., Zeckhauser, R.J.(2008). Demanding Customers: Consumerist patients and the quality of care. Harvard Kennedy School. Retrieved fromwww.hks.harvard.edu/publications/getfile.aspx
Forsberg, B.C., Montagu, D., & Sundewall, J. (2011). Moving towards in-depth knowledge on the private health sector in low and middle-income countries. The London School of Hygiene and Tropical Medicine. Oxford University Press.
Hall, M.A., & Schneider, C.E. (2008). Patients as consumers: Courts, contracts and the new medical market place. Retrieved from http://www.michiganlawreview.org.
Krugman, P. (2011). Patients are not consumers. Retrieved from http://www.nytimes.com.
Yates, R. (2009). Universal health care and the removal of user fees. Retrieved from www.thelancet.com

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