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Healthcare Consumerism: Is the Customer Always Right?

Giancarlo Toledanes, DO

Disclosures

October 11, 2021

In the early 1970s, Burger King launched a marketing campaign aimed at traditional burger powers such as McDonald's. The familiar lyrics went:

"Hold the pickles, hold the lettuce;
Special orders don't upset us.
All we ask is that you let us serve it your way...
Have it your way, have it your way! Have it your way at Burger King!"

The campaign was successful, and for over 40 years "Have It Your Way" became a mantra for getting exactly what you wanted in your burger. In 2014, Burger King further emphasized individuality by introducing its new campaign, "Be Your Way." Fernando Machado, senior vice president of global brand management for Burger King, shared in an interview, "'Be Your Way' is about making a connection with a person's greater lifestyle."

In healthcare, a similar movement in the 1960s to "connect with a person's greater lifestyle" encouraged measures to become more patient-centered and gave birth to the concept of healthcare consumerism. The movement brought positive changes to patient experience, transparency, and access to care. However, challenges remain as patient-centeredness becomes more synonymous with consumer-centeredness in a traditional market context. These challenges threaten to undermine not only providers' ability to deliver appropriate care but the public's perception of healthcare as a whole.

A Brief History of Healthcare Consumerism

In the late 1960s, Enid Balint introduced the term "patient-centered medicine" to contrast with traditional illness-centered medicine. A decade later, the "biopsychosocial" model promoted a more holistic medical approach. In the 2000s, two landmark reports would bring patient-centered care into the national spotlight: the Institute of Medicine's Envisioning the National Health Care Quality Report and Crossing the Quality Chasm.

The first report defined patient-centered care as "healthcare that establishes a partnership among practitioners, patients, and families to ensure that decisions respect patients' wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care." The second established patient-centered care as a core element of high-quality medicine.

The Challenges of Healthcare Consumerism

The goal of patient-centered medicine is to deliver transparent, high-value, shared-decision making via a mutual partnership between physician and patient. The relationship, however, becomes more complicated when, as Rutgers University health policy associate professor Michael Gusmano states, it is "used to emphasize neoliberal commitments to using market forces to effectuate health care reform."

One of the challenges of healthcare consumerism is that healthcare does not operate a market in the traditional sense. In a retail economy, price is subject to supply and demand. Consumer demand can drive up prices if goods and services are scarce.

One does not need to look further than the price of new and used cars in 2021 as an example. Used car prices went up by 30% in June 2021, while new car supplies dropped more than 54% owing to a shortage of an essential microchip.

Traditionally, consumers can negotiate prices down based on supply. In healthcare, however, Gusmano and his group argue, "the main driver of health care costs is not consumer demand, but rather the introduction of new technologies and unwillingness on the part of US political leaders to regulate prices."

Consumers do not hold the same bargaining power in a healthcare market as they do in a traditional market. Gusmano posits that because the United States is dependent on an uncoordinated payment system with thousands of payers, the bargaining power to drive down prices is lost, resulting in high prices for medical services.

Another challenge is one that is currently playing out with the current COVID-19 pandemic. In a traditional market, the consumer's choice is based on preference. But what happens when the preference of the patient goes against standard of care and evidenced-based-medicine?

Ivermectin, a drug typically used to treat parasitic infections, continues to be taken by patients who believe it to be an effective treatment for COVID-19 despite strong CDC and FDA recommendations against it use. Patients have gone so far as to litigate hospitals who do not prescribe the drug. As Gusmano and group contend, "[P]rofessionals do not simply do as they are told...but must act on the basis of knowledge, skill, and fiduciary obligations to patients' well being."

A further question that arises is, how do we address providers who are willing to provide a service or drug that is not recognized as a standard of care? The consequence of not clarifying physician and patient responsibilities in a healthcare market can lead to "doctor-shopping" and an erosion of professional responsibility. As evidenced by the pandemic, there are providers who are more than willing to provide a good or service that goes against evidence-based recommendations.

Patient or Consumer?

The root of the problem is how to define the terms "patient" and "consumer" in a healthcare market. The early definition of "patients" as deferential individuals who submits themselves unquestioningly has given way to one of partnership, information sharing, and shared decision-making.

The rise and expansion of the internet has also given patients access to more information. Like Yelp reviews, patients have databases at their disposal with physician ratings and hospital reviews with which to guide their decisions. This encouraged hospitals to increase investments in patient engagement, more readily address patient complaints, and improve access to services.

A consumer, however, is understood by the public in the traditional market sense. Choices made by consumers are driven by preference, perceived value, and desire for quality. Consumers may seek other's opinions regarding whether a service or good is desired. The influence of consumers, as patient advocate Hala Durrah states, "is in their buying power and ability to share their experiences to improve a good or service."

The incorrect assumption is that the terms "patient" and "consumer" are interchangeable. Historian Nancy Tomes bluntly states that "this linguistic transformation has come to represent the worst consequences of American medicine's growing market orientation."

A True Partnership

It is important for both the public and health providers to remember that the core of healthcare is service to others rather than solely a transactional acquisition of goods and services. By providing the public with transparency, adequate access, and expertise, we not only foster a mutually beneficial partnership but promote health on a holistic level. Hala Durrah concludes, "This type of partnership, with all stakeholders at the table — including patients, families, and all communities, including marginalized communities and vulnerable populations — will lead to innovation and disruption and will empower us all."

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About Dr. Giancarlo Toledanes
Giancarlo Toledanes, DO, is an assistant professor of pediatrics and a pediatric hospitalist at Texas Children's Hospital and Baylor College of Medicine in Houston. His professional interests include quality improvement, health equity, faculty development, and social psychology. When he is not in the hospital, he is a cook and a handyman to his wife, an amateur LEGO builder to his son, an aspiring unicorn to his daughter, and a walking burp cloth to his baby daughter. Connect with him on Twitter: @ ToledanesGian

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