Why the Patient-as-Consumer Metaphor Doesn’t Work for Health Care

by Ruth Seeley

Advocates of patient-centered health care have used the metaphor of “patients as consumers” for years now. Some medical professionalsdoctors as well as healthcare administratorshave bought into the concept. But when the metaphor is co-opted by healthcare critics and advocates of market solutions to healthcare costs, it’s inappropriate and could lead to poorer patient outcomes.

“Pursuing the sensible goal of creating a patient-centered health system will be undermined if consumer metaphors prevail,” said Michael K. Gusmano, Karen J. Maschke,  and Mildred Z. Solomon of the Hastings Center in a recent Health Affairs article. If the customer is always right, physicians might feel they had to defer to patients, which would erode medical professionalism and lead to poorer patient outcomes.

Physicians, who rely on knowledge, skill, and commitment to their patients’ well-being, could feel pressured to resuscitate terminally ill patients, and perhaps to administer unproven, ineffective, or even potentially harmful treatments if “the customer is always right.”

The concept of patient as consumer also puts the onus on patients to reduce health care costs, even though they don’t operate within a real market like real consumers. Without the time to research or the information to make informed choices, patients may not be able to choose the best health care for them based on quality, price, and other factors like convenience. And they may well not have the time to shop for different health care or treatment options.

While making patients pay more out of pocket does cut overall spending, it also means patients use less appropriate and fewer essential medical care services.

“What does drive up health care costs 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,” said Gusmano and his co-authors.

Source:  The Hastings Center

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