Envisioning 2.0

Last week, I asked readers of Grand Rounds to submit posts about consumer-driven healthcare. One of the reasons I decided to focus on this issue was because President Bush made healthcare a major focus of his State of the Union address last week. In what some might call a policy wonk’s dream speech he made a proposal that (if it became law) would begin the long and difficult process of decoupling health insurance from employment. One potential consequence of providing tax breaks for health insurance would be that some uninsured individuals may be encouraged to purchase it.

Focusing on tax policy is just one of the tactics employed by those would like patients or “consumers” to take more responsibility for managing their care. Over the past decade or so, healthcare economists, policy analysts and others have touted “consumerism” as the solution to the United States’ health cost woes. The country currently spends a significant percentage of its gross domestic product on healthcare. Proponents of consumerism argue that one of the reasons that healthcare spending continues to rise is that patients are shielded from the “real” costs of care and often utilize more medical services than they need.

Unfortunately, the conversation about consumer-driven healthcare has been largely limited to the ivory towers of government, academia, corporations and the media. Many Americans are not aware of healthcare consumerism and need to learn more about it. This was one reason why I decided to make this topic the theme of this week’s Grand Rounds. Given that some regular contributors have said they do not like themes, I was worried that my request would result in a very bare bones edition of this well-respected blog carnival. I needn’t have worried. I received more than 35 submissions for this edition and the vast majority dealt with healthcare consumerism. Following are the 25 posts I selected. Happy reading!

What Is Consumer-Driven Healthcare?

Although supporters of consumer-driven healthcare (CDHC) argue that it will give consumers more power to control their medical destinies and improve quality, some believe that it is being abused. David Williams, of the Health Business Blog, says that it is misused by “employers [who are] using the shift to high-deductible [insurance] plans as an opportunity to take their cost savings up front, at the expense of their employees and the whole concept of consumer-directed care.” He also gives a succinct definition of CDHC in the introduction to his post.

Henry Stern of InsureBlog chimes in with this timely post in which he argues that employers are woefully “unaware of the benefits of high-deductible health insurance plans for their employees.”

Consumer-Driven Healthcare: Its Philosophical Underpinnings

Some proponents of consumerism are opposed to single-payor healthcare. This is because they believe government-mandated coverage will wrest control from consumers. In addition, many supporters of single-payor believe that healthcare is an inalienable right. Others say it is not. However, the debate is far from black and white. In this post, Kim of Emergiblog argues that healthcare is not a right or entitlement, but a need. In addition, Kevin MD contends that “healthcare is absolutely not a right.”

What Are The Consequences Of Placing More Financial Burden On Patients?

As mentioned in the introduction, proponents of consumerism want to place more financial responsibility on patients because healthcare costs continue to rise. However, some are bemoaning the consequences of consumer-driven healthcare. In this impassioned post, Kerri, who writes the blog Six Until Me, relates her reaction to propoals that promise to give consumers more control over “price and quality.” Her conclusion: “If [healthcare reform] legislation passes, it won’t be price and quality, but price or quality. You either chose the best care available and pay an obscene amount for it or you chose what you can afford.”

In addition, Universal Health highlights a new study indicating that consumer-driven plans are causing more bankruptcies due to healthcare costs. On the other hand, Shrink Rap reports that the well heeled are spending $1,700 per day for psychiatric treatment at expensive retreats.

As much as we argue about the pros and cons of healthcare consumerism in the United States, many around the world are already practicing it. With no reliable insurance, any care they receive is paid for out of pocket. For example, in Mexico some patients are financially responsible for everything from medication to prosthetic devices. Unbounded Medicine relates the story of a Mexican engineer who has developed a low-cost, highly-effective artificial arm. The prototype’s price tag? $1,800.

At the other end of the spectrum a country with universal health insurance, The United Kingdom, has been experimenting with tools developed to help empower consumers. Steve Pashley wonders if the NHS can become “sufficiently permeable to customer experience.”

What Do Patients Need To Take Control Of Their Care?

Boosters of consumer-driven healthcare say that patients cannot become true consumers without education and information. This is one reason Revolution Health’s founder Steve Case has spent millions developing a Web portal and other tools to help consumers take control of their medical care. However, one of Case’s potential customers, Kerrie, has little use for his new venture.

Other entrepreneurs have also leapt into the breach, launching Websites like RateMDs.com that feature patient ratings of doctors. Although some welcome these efforts, Liana gives RateMDs.com and sites like it a big thumbs down.

I think that the author of Bikers and Coffee Shops would welcome consumerists’ push for more healthcare information. She relates the story of how her husband could have benefited from more education after undergoing a complex medical procedure.

One of the major benefits of the medical blogosphere is the fact that patients have access to excellent information that will help them become better “consumers” of healthcare. These posts illustrate why:

-Inside Surgery provides information on how surgeons remove thyroids

-Bertalan Meskó highlights how video games are being used to help cancer patients

-Cyndy King offers tips on how to become a more empowered cancer patient

Another group of bloggers believes that patients need to be educated on the benefits of prevention in order to decrease medical costs and increase quality of life. For example:

-Tony Chen of Hospital Impact relates the efforts of US Preventive Medicine to “put in place programs, protocols and procedures that detect and treat health risks early, preventing them from becoming life-threatening diseases”

-Rachel says we need to do more to decrease obesity through prevention

-Anxiety, Addiction and Depression Treatments believes we need to “take measures, no matter how small, to ensure a healthier population before treatments even begin”

Is Decoupling Employment From Health Insurance The Answer?

President Bush’s proposal to provide individuals and families with a tax break on health insurance received a lot of attention in the healthcare blogosphere last week. Jason Shafrin, author of The Healthcare Economist, takes a look at the implications of Bush’s plan. He concludes that it is a boon for the rich.

On the other hand, Roy Ramthun praises the president’s proposal as “a bold step to correct the historical mistake made over 60 years ago that has forever linked employment and health insurance coverage and created a medical arms race that is consuming our economy.”

Finally, Moreena has a serious headache and it’s Bush’s fault.

Are Patients & The Healthcare System Ready For Consumerisum?

Are patients and the healthcare system really ready for consumerism? These medical bloggers suggest they are not.

For example, physicians are the most educated healthcare consumers you are likely to ever encounter. Yet, even Medpundit was a bit daunted by her recent visit to the emergency room on behalf of her son.

Amy Tenderich of Diabetes Mine shares the latest in her ongoing effort to become an insulin pumper. Tenderich is a very informed consumer, but is still stymied by insurance company-related bureaucracy and red tape.

In a post that’s not for the faint of heart (or, squeamish), Dr. G. C. George asks why are his Malaysian patients taking so long to seek treatment?

What’s The Bottom Line?

Supporters of consumer-driven healthcare believe it will help reduce costs and boost quality. They also think that it will improve access to care. This is vitally important, as this post from Mother Jones, RN reminds us. If consumerism can meet these needs, I’m all for it. If not, we will need to find another solution.

Thank You & The Next Edition

Thank you for reading this edition of Grand Rounds. Next week’s installment will be hosted at tales from the emergency room and beyond . . .

This entry was posted on January 30, 2007 at 9:00 am and is filed under Grand Rounds, Health Policy. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.