Patients are not the customer

Ever been put on hold when calling your insurance carrier? Or had so little time with your physician that you could not discuss everything you thought was important?

Our care is generally good in the United States but not as good as it could be nor as good as it should be. There are multiple problems to consider.

First, ours is a medical care system not a health care system. It is a system that focuses on disease once it has occurred but gives relatively little attention to maintaining health and developing wellness. Clearly there is a need for greater attention to disease prevention and health promotion.

Second, the system developed over many decades to care for acute illness but today America is faced with more and more chronic diseases. Sure there are still patients with an ear infection or a broken leg. But more and more individuals are developing diabetes, heart failure (both of these now becoming epidemics), cancer, chronic lung disease and others. These are illnesses that generally last a lifetime, are complex to manage and inherently expensive to treat. They are best handled by a multi-disciplinary team coordinated by a primary care physician. But such is seldom the case today.

Third, of course, many do not have health insurance with some 47 million uninsured and many more underinsured. And as they obtain insurance or join the Medicaid ranks as the result of healthcare reform, there will be way too few primary care physicians to care for them. They will therefore continue to use the emergency room as their principle place for care.

Fourth, our system of care is not customer-focused. We wait long weeks and months for an appointment, spend long times in the waiting room and are frustrated that we get just 12-15 minutes with our doctor. Our doctor suggests that we go to a specialist but does not personally call the specialist to explain the issue nor to smooth the path for a speedy appointment. We are not really his or her customer in that we do not pay for the services rendered except for a small co-pay or deductible. So it is not a typical professional-client relationship.

And fifth there are the insurers. We are not their customer – our employer is their customer or our government is their customer – but not us. And it shows – by our long waits on the phone, by the complex often hard to understand paperwork and by the frustration when the insurance we thought we had does not cover our latest tests, x-rays or specialist visit.

Indeed we are not the insurer’s customer nor are we the doctor’s customer. The physician is the customer – sort of – of the insurance company. We are mere bystanders. This is hardly the type of contractual relationship we have with our lawyer, architect or accountant.

So a new vision for our system must make it a healthcare not just a medical care system. It must recognize the importance of intensive preventive care to maintain wellness. It must address the needs of those with chronic illnesses (who consume 70-85% of all healthcare claims paid) to both improve quality of care while dramatically reducing the costs of care. And it must be redesigned so that the patient is the customer that he or she should be – of both the physician and the insurer. It’s doable but it means a rethinking of how our delivery system is structured.

Patients are not the customerStephen C. Schimpff, MD is an internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center and consults for the US Army, medical startups and Fortune 500 companies. He is the author of The Future of Medicine – Megatrends in Healthcare and The Future of Health Care Delivery, published by Potomac Books. 

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  • Dale Coy

    Yes there will be a shortage of 167,000 physicians by 2025.  So, what are we doing to retain doctors who are currently practicing.  How about tort reform so we won’t retire early to protect ourselves from one malpractice lawsuit causing financial ruin?

    • Anonymous

      “How about tort reform so we won’t retire early to protect ourselves from one malpractice lawsuit causing financial ruin?”

      Doctors who believe that malpractice lawsuit awards are unfair are not looking at the actual numbers – actual numbers. In fact, they are insignificant overall, and rarely even awarded.

      Better to look at the premiums that malpractice insurors charge. There is no relationship between their premiums and payouts or actuarial risk. They have doctors at their mercy, and actually drive good doctors into unwanted retirement.

  • Dike Drummond MD

    If any system could be designed to make LESS SENSE than the goulash of payment mechanisms in the USA … I would eat my socks right here.

    I agree with you Dr. Schimpff that it leads to atrocious patient care. In any given week your worst “customer service” experience is usually at the doctors office. Oh … yes, that’s right … we aren’t the customer. Being a “Patient” is akin to being in Limbo then …

    This same disjointed system leads to another massive negative consequence that typically stays under the radar. It is a HUGE stressor for the Physicians and other providers. Just ask them why their burnout rates average 33% across all specialties every day … and all will put the stress of paperwork and insurance issues at the top of their list.

    You outline the problems well … what are the solutions? It would not appear to help anyone by layering “reform” on top of this mess. In Real Estate we would call this house a “scraper”, knock it down and start over. Is that even possible?

    My two cents,

    Dike Drummond MD

  • Mimi

    Just another of the many reasons I’m lucky to have been born in Canada!

  • Mimi

    Just one of the many reasons I am very lucky to have been born in Canada.

  • S.C.

    Very easy for this guy to say, he who runs in ivory tower circles having already made his money as a CEO of a huge hospital system. In real life its far more difficult to enanct such changes, and I sure didnt see any suggestions. Of course it spawns the tiresome “oh, I’m so glad I live in Canadia or Europe!” posts. And what kind of doctors does this guy go to where he waits months for an appointment?

    • Anonymous

      “And what kind of doctors does this guy go to where he waits months for an appointment?”

      You can believe any unsubstantiated bumper sticker myths you like but you will not find more than a few Canadians or Europeans that would trade their situations for ours.

      Their doctors feel the same way. Only when budget negotiations are afoot do Canadian doctors moan about money issues. The rest of the time they love their system. Don’t believe me. Ask them.

  • Marc Frager

    Direct pay patient care is an answer. Cut out the government and middlemen and have the doctor working directly for the patient. You can bet that customer service will improve by leaps and bounds. Direct pay care does not have to be extravagantly expensive. Several models exist to provide direct pay primary care at a reasonable fee by eliminating bureaucratic regulations. When the doctor and patient are working together with shared interests,  both will likely be much more satisfied than they are currently.

  • Kathy Nicholls

    Interesting post and while there are some good points to it, I’ve never  wanted to be a “customer” in health care. I want to be a participant, one of the team that focuses on what’s the right choice for my own health and those loved ones for whom I am the advocate. And while I find that’s sometimes hard to find in a healthcare provider (one who truly understands the notion of participatory medicine), when I do find one who gets it, the results have been amazing.

  • Ardella Eagle

    It is a sad, sad day when a physician refers to their patient as a ‘customer’.  It needs to be a RELATIONSHIP.  A customer comes in, makes a purchase based on their needs/wants, and leaves.  A patient looks to the physician for guidance to their health and well-being–not just in and out without any discourse.

    All I hear in this blog is aggrevation, and rightfully so. However, trying to turn a human experience into a cookie-cutter consumer model isn’t the answer.

    • Anonymous

      Patients are customers, doctors are providers, and medicine is health care. What was once a profession is now a service industry, complete with third-world call centers.

      Most docs are too tired to fight this crap any longer.

    • Doug Capra

      “It is a sad, sad day when a physician refers to their patient as a ‘customer’.  It needs to be a RELATIONSHIP.”
      Let’s be realistic. Yes, the relationship between a doctor and patient is complex, comprising many elements. But one element is money. The doctor is getting paid. The myth that insured patients aren’t customers is interesting. Healthcare benefits replace salary increases and raises. Employers consider health benefits part of a salary paid, so insured patients have “earned” that coverage. This relationship can be more than a customer-professional relationship. Doctors can be friends, mentors, advisors, etc. But their patients, in addition to playing all those roles, are also their customers.
          With the web and all the social media, the whole notion of customer service is changing, rapidly. A complaint or story can go world wide quickly. A post on youtube can get millions of hits overnight, and the next day the complainer could be on Good Morning America. The medical culture better get in touch with this reality, rapidly. They need to learn that among other things, their patients are also customers. And they need to learn how to better communicate with their patient customers.

  • Irene Steinheuser

    Disease death are the consumers

  • Mark Shackelford

    Good article, thanks!  The medical care system vs. health care system on the surface sounds like splitting hairs.  The article demonstrates succinctly that not only is this perspective difference short sighted, the rising costs of the differences are becoming unsustainable.

  • Anonymous

    This is a policy setting view–not the physicians’ point of view, which is far more patient focused (doctors don’t think or say “customers”). This follows the money: it describes who the key decision-makers are in the US medical care industry: govt (CMS covering Medicare and Medicaid; VA benefits, etc), large business as personnel policy purchasers, and insurance companies that define what is covered. Health care consumers need to understand and advocate the right power holders, accept that prevention is most effective, and adopt behaviors that support better health (and their own financial controls re copays, deductibles, independent living, etc).

  • aelfheld

    Funny that there’s absolutely no mention of the 800 pound gorilla in the room – the federal government and its effect on both financing and delivery of health care.

    It was the federal government that enshrined the idea of the third-party payer into law (via the tax code) and then reinforced it through Medicare / Medicaid.   Add to that the enormous distortion of federal and state regulations imposed on insurance companies and its not difficult to see why things are a mess.

  • Sherry

    Actually many many of us DO pay for our own care as well as that of our families and employees. In WA state over 300,000 people purchase their own health insurance and if we were part of a group plan would be the largest purchaser in the State. We have the worst rates and the least ability to negotiate so I am really don’t see how shifting costs to patients will somehow change the dynamic with providers?

    The rapid growth over the past generation in chronic condtions didn’t happen because of some flaw in customer service or payment mechanisms. In addition to a sick care system there are a myriad of other issues ranging from all sorts of unconnected things – immigration (1 in 10 adults) portion sizes, marketing, corn syrup, use of computers for play, smaller families, longer work hours,

    It would be so nice if it was really as simple as better customer service though.

  • Anonymous

    The answer is not to turn patients into customers and providers into purveyors of medical care anymore thatn it alreayd exists today.  It was proven over one hundred years ago that when you give Physicians an open market that more and more services are sold that are not medicallyl necessary.  In medicine the so called customer or patient is not sufficiently knowlegeable to protect themselves in the market.  It has also been shown throughout history that the more money that can be had the more ethics are compromised.  Healthcare is not a service that lends itself to a buyer beware market.  The providers will be the purveyors for years to come, but unless the payer becomes a non-profit patient advocate and protector I am afraid we will continue to pay more for less.  Unless the patients cansomehow harness group purchasing and the power to demand real quality the patient will remain defenseless in the market.

  • Don Stumpp

    I challenge our group that if we are truly ‘patient-centered’ – why do we turn our phones off at Noon?
    Really?  we havent figured out how to rotate lunch assignments so that someone can answer a phone or take a message?   Did we ever think our patients might have jobs that might want THEM to not call during THEIR working hours? 

  • Thad Puckett

    I honestly don’t think the insurance companies or government bureaucrats want the patient to ever understand just how much they are mere fodder for the system.  If patients were to ever actually become consumers (in the truest sense, where a market for health/wellness services were created and used), cost would go down, insurers would move to other businesses, and the power of government would decrease.

  • mamatha

    I completely agree with you, I work for a county hospital and often I see what patients go through to even  see a primary physician. You bring out the interesting point as to doctors and organization being the customer of the insurance company. Although I am paying the premium for the insurance company, however, they behave like they are providing free service. I hope government will be involved in placing some restrictions as to what insurance company should do. If you I do not pay the premium, there is not chance for insurance company to exist.

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