Health consumers: A long way off

We keep hearing the term “consumers of health” but the American healthcare system is too profitable to allow people to be consumers of healthcare. “The need for action now is clear. Health care costs are climbing so fast they may soon threaten the quality of care and access to care which Americans enjoy.” Ronald Reagan.

What if … people got a fair ROI for healthcare spending the way we expect a reasonable return from other investments? What if people could apply the experience to healthcare?

These are questions Ms. Sarasohn-Kahn tackles in her book HealthConsuming: From Health Consumer to Health Citizen. It’s a good read but ignores a simple fact. Our healthcare system makes too much money for insurers, PBM’s and pharma companies to change.

The United States spends more on health care, and more per person, than any other nation on the planet. U.S. health care spending reached $3.7 trillion in 2018 – about $11,200 per person. Health care spending is approaching nearly one-fifth of the U.S. gross domestic product. That’s $1 in every $5 in the national economy. By 2026, national health expenditures will reach $5.7 trillion – over $16,000 per capita.

As people become more engaged health consumers, they’re defining personal health across many dimensions: physical; mental, emotional, and spiritual; external appearance (how we “look” directly shapes how we feel about our health and wellbeing); and, financial. The emerging health consumer isn’t so much seeking to consume health care. S/he’s in search of health, wellness, and betterment.

Today, just as many people trust retailers and digital companies to help manage their personal health as they do health care providers.18

Consumers are seeking and embracing health outside of the traditional bricks-and-mortar sites of hospitals, doctors’ offices, and diagnostic centers. Health is made where people live, work, play, pray, and learn: in their communities. Technology is increasingly enabling care to be delivered in these more accessible, convenient, lower-cost venues that can both engage people in their own care and drive health care costs down for all payors – especially for the consumer/patient as payor.

But there are problems. “Today’s high deductibles are tomorrow’s bad debt,” a Moody’s analyst wrote. Forty-three of fifty U.S. states were given a grade of “F” for failing to provide a minimum standard of health care price transparency.

Consumers know that shopping for health care is challenging, in terms of unearthing and comparing costs of different providers, predicting coverage and out-of-pocket costs, determining the best value across care options, and identifying timely discounts and savings opportunities: the very work tasks that makeup “shopping.” But as Tina Rosenberg wrote in the New York Times, “There is practically nothing we shop for the same way we did 15 years ago. Except in healthcare. Most of us still buy blind.”

Consumers still feel uncertain about making health care decisions: most people don’t know how much they need to save for health care costs and aren’t confident they have maximized their health tax benefit. Consumers are much more comfortable shopping for a TV, a car, picking a mobile phone provider, and booking travel themselves. Shopping for healthcare? Not so much.

We live in the grand age of consumer review sites on TripAdvisor, Yelp!, and Zagat. But no such comprehensive site exists for healthcare in our local markets.

The new healthcare consumer is faced with the challenge of both shopping and saving: shopping for the price of prescription drugs or healthcare services, and saving to pay for deductibles, out-ofpocket costs, and unanticipated medical emergencies.

In 2016, consumers told Aflac that enrolling in health insurance should feel like an experience on Amazon. They want to know exactly what they’re getting for their money. Health consumers are hungry for Amazon’s brand of transparency, convenience, and streamlined interactions for medical care.

Transparency in health care can bring greater empowerment and enable more rational decision making for health consumers. There’s evidence that patients will embrace transparency in the form of accessing their physicians’ notes about them, based on the OpenNotes project which showed higher engagement in patients that had access to HCP’s notes.

While most health consumers use the internet to seek health information, there is a growing cadre of people who go online to find people with the same conditions they have, or to touch base with other caregivers experiencing similar situations. Social media enables people to be better health consumers by giving them peers’ views on medical conditions, health products, and health services in and outside of their physical and geographic communities.

Why does this happen? It’s simple: people trust each other more than pharma companies who they view with a high degree of skepticism.

While this book is a good and fast read it ignores the political and financials motivations that keep our healthcare system complicated. PhRMA is still pouring cash into politicians who are willing to fight for high drug pricing. Until healthcare consumers become more vocal and there is more disruption the industry players will continue to make a fortune.