Patients as Consumers
What Does Health Care Consumerism Mean for You?

By Susanna Donato
Susanna Donato is a writer for Physicians Practice

A generation or two ago, patients tended to be passive, were not apt to ask questions, and seemed happy to cede responsibility for their health to their physician. The physician’s job was to diagnose the patient’s problem and set forth a plan for treatment. No one gave much thought to the cost of care — patients (or their insurance companies) paid the bills. When they couldn’t afford to pay, poor and uninsured patients often offered homegrown produce or fresh eggs from the farmhouse to the physician who had treated them. Times were simpler.

Today, patients are known as “consumers” of health care, and their approach reflects that role as they demand more choices, higher quality and value for their health care dollar. The growth of health care consumerism — including consumer-directed health plans (CDHPs), direct-to-patient advertising and Internet health care information — stems from ongoing concerns about rising health care costs.

“For 50 years, health care has developed in a bubble outside the free market,” said John Blanchard, M.D., a Detroit-area physician and founding member of the Society for Innovative Medical Practice Design. “We see the cost of health care skyrocketing and the quality of health care delivery going down because there are no forces to bring those factors in line.”

The Boston University School of Public Health has reported that health care spending this year will account for 16 percent of the U.S. economy. As a result, employers and payers are turning to coverage models that give consumers an increased role in determining how their health care dollars are spent.

Patients at the wheel

A recent employer survey found that 22 percent of companies now offer a CDHP to employees. Of the employers not currently offering CDHPs, 50 percent plan to offer them in the future. (See box below.)

“Medical practices are businesses too, and I’ve seen a positive reaction [to CDHPs] from physicians … in terms of health coverage for their employees,” said Elizabeth Woodcock, FACMPE, a practice management consultant in Atlanta.

Typically, a CDHP is a high-deductible plan ($1,000 to $3,000) associated with an individual health savings account (HSA), where funds can accumulate to pay health care bills that are not covered by insurance. The HSA belongs to the employee and can be transferred from job to job, with remaining funds used in future years for health care expenses or long-term care.

Many CDHPs also provide information about conditions, providers and health care costs. Some exempt preventive health care (especially for children) from the deductible, providing immediate coverage. Additionally, some states mandate predeductible coverage of certain tests, such as Pap smears and prostate exams.

Together, these new arrangements will shed new light on how patients view health care, some in the industry believe.

“The patient is really driving the car, and so, the patient is going to search out the best quality and service from his or her doctor that he or she can, for the money that he or she is paying,” said Blanchard.

Isaac Eliaz, M.D., a physician practicing integrated medicine in the San Francisco area, agrees: “[HSAs] give the flexibility to go to whomever you want, which also puts pressure on the doctor: When patients come to me, it’s because they want to see me.”

Access to information is growing

One growing avenue of consumer information is direct-to-consumer advertising of prescription medications. Critics wonder whether this pressures physicians to prescribe certain products in response to patient requests. But in a recent survey by the Food and Drug Administration (FDA), 91 percent of physicians said that discussion of drug advertisements does not influence treatment in a harmful manner.

The same study also indicates that advertising boosts sales for an entire drug class — a signal that the advertising inspires more communication between physicians and patients about patients’ conditions and treatment options.

Similarly, the availability of Internet health information has some concerned that patients will trust faulty information or not get the full picture.

“Internet information lets patients take more control, but one issue is that there is no control over the information that is given on the Internet,” Eliaz pointed out.

A 2003 study published in the Journal of Medical Internet Research found that 85 percent of physicians reported having patients who brought information they found online to a visit. According to that study — as most physicians would predict — accurate information benefited patient health, while inaccurate information harmed outcomes and physician-patient relationships.

While increased access to information can make patients healthier, the researchers also found one especially interesting fact: a minority of physicians, who believed that patients challenged their medical authority by bringing information to the visit, consistently experienced deteriorating physician-patient relationships or worsening health outcomes.

Yet the study found that most physicians are positive about the increasing availability of health information online, and many use the Internet in their own practices. Internet-savvy patients, however, are wary of receiving inaccurate information from sources they’re not familiar with, which gives physicians a great opportunity to support patient consumerism with strong information sources.

“One thing we’re doing right is finding more information that we can offer to patients,” noted Vicki Rackner, M.D., a Seattle surgeon. “Doctors are beginning to understand that information is powerful medicine, so they are getting involved in the process by getting information onto their Web sites and telling patients where they can go to get good information.” (See box below.)

Supporting patient choices

Part of responding to health care consumerism is giving patients information about practices to help them choose the right physician for them.

“We plan to put right up on our Web site some very objective metrics that people can look at to evaluate our practice,” said Blanchard. “[For example], that waiting time in our waiting room is zero, and average face-to-face time with patients is an hour.”

“Consumer-driven health plans bring with them an inherently greater understanding of health benefits by patients,” said Woodcock. “That said, I still believe that physicians are going to have to play an advocacy role with their patients, meaning they’re going to have to [support] patients in understanding their health benefits.”

Woodcock suggested that physicians ensure that their office staffs learn about the new health plans so that they can clearly explain patient responsibilities. “Develop a relationship with benefits officers, and then, if patients have questions, you can refer them there,” she said.

Woodcock also acknowledged that front-office staff cannot possibly grasp the details of every plan, but online plan information can support front-office conversations with patients, as well as support the practice’s efforts to be paid appropriately.

With patients becoming savvier about health care options, physicians will find marketing becoming more important.

“The consumer model restores competition in health care at the disease management level,” Blanchard noted, meaning that patients will choose physicians based on recommendations and outcomes.

But in some ways, consumer-driven health care makes attracting patients as simple as recalling our common needs. “Today, I’m a doctor; tomorrow, I’m a patient. It’s important to remember that we are all patients,” Eliaz said.

The good news is that better-informed patients tend to be healthier. When a patient takes an assertive role in managing his or her health, use that opportunity to open the lines of communication about the patient’s health concerns.

“Doctors can either resist it or they can embrace it and learn from patients,” said Eliaz.

Back to top