The New York Times recently ran an op-ed by Paul Krugman with the intriguing title, “Patients Are Not Consumers.”
Here’s an open letter to him:
Dear Dr. Krugman,
As a comparative effectiveness researcher, I agree with many of the arguments that you are making in your most recent article. However, I disagree with your main point that patients are not consumers.
I understand your sentiment and agree that patients are more than consumers just as doctors have more obligations than their own (financial) good. However, it is not just House Republicans, as you seem to suggest, that favor “consumer-based” medicine. Business economists Michael Porter and Elizabeth Teisberg base their entire theory to shift competition from health plans (you mention the failed Medicare Advantage idea) to individual clinicians and facilities based on the patients’ informed decisions in the market.
Patient-driven medicine is also more than just vouchers for seniors. Just look at e-patients like Dave or the Society of Participatory Medicine or former hospital CEO Paul Levy who rightly point out that patients are the most under-utilized resource in medicine and that health care process should not just be patient-centered but patient-driven.
Clinicians’ help to patients to navigate the health care system is essential. Patients will often be guided, for instance, in referrals to specialists by their primary care physician, if they happen to have one. America’s health care system, unfortunately, is so fragmented that in reality patients often need to find their information on their own, at least at some point along the way, or through families and friends.
I feel strongly that patients should essentially be engaged and empowered and have access to a wealth of information, from medical conditions to outcomes of individual medical providers or facilities.
Comparing and selecting providers of clinical services (yes, I would call doctors and others that) even if they might not pay the entire bill is an essential feature of engaged and empowered consumers.
Nevertheless, health care will never be a perfect market. Patients need to put difficult-to-digest information into context to be able to make use of them. A discussion with the clinician of your choice is most often invaluable and often cannot replace other ways to interpret information. Since you, Dr. Krugman, are an economist, I am wondering why you missed out on naming the imperfect condition in question: information asymmetry.
Benjamin P. Geisler is a comparative effectiveness researcher who blogs at Health Care Value Strategies.
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