Monday, April 25, 2011

Patients Are Not Consumers

Paul Krugman Patients Are Not Consumers "Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as ‘consumers’? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough."

An ER doc blogging in Movin' Meat also wrote, Why Patients are Not Consumers. There more to it than he states. Try asking a doctor at a hospital what various treatments costs, he probably doesn't know. It's hard enough to figure out what treatment you want if you can determine the options, try shopping around to compare prices. And of course none of this applies if you're brought into a hospital unconscious.


Karl said...

It seems to me that insurance companies are actually the consumers of medical services. I don't have a full understanding of how the interactions work, but aren't they responsible for negotiating prices and choosing which doctors and procedures to allow? Patients are consumers of insurance (or there is an additional level of indirection for people who get insurance through their employer).
This weakens some of the arguments that patients aren't in a position to make choices, but of course raises a whole new set of issues about difficulty of comparatively shopping for insurance. The fact that it is at best complicated to switch insurers also tends to dampen market based effects. Plus, the profit motivation of insurance companies goes in both directions: squeezing providers where the impact is fairly concentrated and squeezing people where the impact can be amortized.
The biggest problem I see in controlling health care costs is the idea that everyone deserves the best level of care available (i.e. rich people shouldn't get better care). And this, to me, is a big moral dilemma. Certainly limiting procedures to those know to be generally effective will control costs, but it means denying people without independent means procedures which could have some impact.

Howard said...

Yes, it is all muddy as to who's the consumer. There's another layer in that since most people get insurance from employers, it's employers who pick plans from insurance companies and make them available to their employees who might become patients.

I don't think there are any plans that say everyone deserves the best care possible. They're trying to provide a reasonable care. Even medicare doesn't support everything and many people get supplemental medicare insurance (often from AARP). I'm not sure if countries with real nationalized systems (like England) have additional private options available.