- Consumerism in healthcare is here to stay, but the industry needs some fixes to drive patient empowerment and assist patients who face growing financial responsibility, according to a policy brief from healthcare researchers at Rice University.
Patients are increasingly prepared to interact with the medical industry as consumers rather than as passive patients, the report authors noted. Through interactions with other services industries, patient expectations about healthcare experiences have changed, said Vivian Ho and Anaeze Offodile.
Ho is the James A. Baker III Institute Chair in Health Economics and director of the institute’s Center for Health and Biosciences, while Offodile is a physician at the University of Texas MD Anderson Cancer Center.
“We live in a world where an individual’s discretionary choices (food, clothing and travel) are increasingly driven by convenience and amenability to control — for example, online shopping — and the prevalence of mobile apps,” the authors wrote. “These attitudes will only heighten with future generations and it should come as no surprise that they greatly influence how people interact with the health care sector.”
As a result, health insurance benefits have shifted. Healthcare payers are meeting patient expectations by putting beneficiaries in the financial drivers’ seat, giving patients more control over their healthcare choices while also increasing the financial burden. This trend is visible in the increased enrollment in high-deductible health plans and health savings accounts.
“The idea that patients— i.e., consumers—should be given more purchasing power and, consequently, individual responsibility over the utilization of health care services that relate to them has translated into a redesign of health insurance benefits: consumers now bear more out-of-pocket health-related expenses (through high deductibles) before cost-sharing with the insurer kicks in,” the researchers pointed out.
Healthcare payers offer high-deductible plans, health savings accounts, and health retirement accounts to give patients the means to pay for their healthcare the way the patient chooses. Instead of a prescriptive approach to medical treatment, these models generally allow patients to select where and how they will spend their healthcare dollars.
Healthcare payers want patients making the most fiscally responsible decisions about their healthcare, decisions that will be driven by patients putting their own money on the line. Patients engaging in these payment models can choose between generic and name-brand drugs, specialty or primary care, and other treatment decisions that can impact both cost and care quality.
“In theory, this should help check health care costs by incentivizing the use of lower-priced options and reducing unnecessary variations in health care utilization,” the researchers said.
For example, health payers want patients “shopping around” for the most cost-effective deal on a surgery or a procedure.
But right now there isn’t a strong enough culture of patient consumerism to make it an effective and beneficial deal for patients, the report authors pointed out.
If a patient is shopping around to select where she will undergo surgery, she should be able to see patient satisfaction, clinical quality, and cost transparency data to help support her decision. The patient should also have access to her own medical information to put her choice into context.
Currently, those tools are not readily available, the researchers said. Patient engagement tools and practices are not sufficient to meaningfully empower patients as the arbiters of their own care. Patients don’t know enough about their own health, the healthcare system, or healthcare costs to be in charge of these decisions.
Simply putting the information out there is not enough, the authors contended. Patient portals are widely available, but adoption is low and actual patient use is even lower. Many states enforce requirements for displaying healthcare cost transparency, and although patients support this kind of information they aren’t using these tools either.
“It is clear that quality and cost data need to be labeled and disseminated in a format that is easy to understand, actionable, and minimizes misinterpretations,” the report authors argued. “In other words, at the point of purchase, patients should be provided with the tools to enable them shop around for the care that best serves their needs.”
For example, the patient satisfaction star rating systems for Medicare Advantage plans have been tied to higher enrollment in higher-rated plans.
New healthcare policies that benefit patients will also be better drivers of consumer-centric healthcare, the researchers pointed out.
“Tools that work to improve the quality of decision-making and provide incentives that encourage smarter ‘health care shopping’ will also be crucial as we move forward,” the report authors stated. “It is widely agreed that fiscal incentives can be a powerful lever for behavioral change, if harnessed well. Creating arrangements whereby consumers get to keep a portion of any savings generated from utilizing a lower cost option would go a long way toward engaging the public in health system changes.”
Additionally, healthcare industry leaders must re-establish patient perceptions of healthcare utilization, specifically that more care is not always better care. As medical professionals continue to embrace the notion of quality over quantity, as too must patients.
Consumerism in healthcare also faces barriers when patients still pay less than full sticker price for procedures due to comprehensive insurance coverage. Complex medical systems and limited patient education and knowledge about health also hinder healthcare consumerism.
When patients seek medical advice for an unknown ailment, consumerism also falters.
“Health care consumerism works best in situations where the treatment course or service to be utilized is discrete and clear—e.g., diagnostic imaging, lab tests, cataract surgery, or outpatient colonoscopy,” the team explained. “In these situations, consumers can focus on pursuing the lowest cost, high-quality provider or option. Consumerism is much less helpful when patients are not well-informed or providers earn more for prescribing higher cost treatments.”
Consumer-centric healthcare is likely here to stay, the report authors asserted. Healthcare organizations have already created constructs to make healthcare more convenient and patient-centered.
“The increasing prevalence of walk-in clinics, patient experience/satisfaction surveys, online physician reviews, telemedicine and concierge medicine speak to this,” the authors concluded. “More importantly, they add an air of permanence to the present consumerism movement.”