Rise of the empowered healthcare consumer — A starting point for healthcare transformation
The last two decades have seen a shift in the dynamics of doctors’ consultation rooms. Informed patients have begun to push away on the paternalistic “I know best for you’ doctors and started demanding more from their healthcare providers. This rise in healthcare consumerism follows on the heels of a similar consumer led transformations of the travel, retail and banking industries, amongst others.
Other industries lead the rise of the empowered consumer
Consumerism is defined as the protection or promotion of the interests of consumers. The internet unleashed an information revolution in the 90s that placed more data at the hands of the consumer. Armed with vital and relevant information, consumers across industries started making choices they were not able to even a decade back. You now had information about hotel rooms halfway across the world, could book a flight from Chicago to Austin sitting in Pune and could order your favourite item from Amazon from anywhere in the world. Consumer choices led to rapid transformation of many of these industries, ultimately improving the experience for both consumers and suppliers.
Consumerism in the healthcare industry can also trace its recent origin to the 90s and the mushrooming of healthcare information websites. Sites like WebMD and good old Google brought complex medical information into homes and to patients, hungry for more information. All of sudden, myocardial infarction and schizophrenia were not exotic names that only doctors could shed light on. Everyone with a computer (or anyone who knew someone with a computer) could now read everything about medicine. There have been other sources of information for the healthcare consumer in the past (the Merck Manual is still a fantastic and credible read) but none that could reach billions of people around the world as fast as the internet did.
What has changed?
With the demystified world in their hands now, the healthcare consumer began to change the conversation. It started with the informed patient asking questions, demanding answers to conditions they now had read about. Doctors and hospitals had to start adapting to the new informed consumer — now they had to start communicating more with the patients. And with increased information (and some increase in knowledge), patients started to assert their opinions. “This doctor made me wait, the hospital is dirty, they charged me too much, they are a great surgical team, here’s what you should be asking your doctor”… Suddenly, opinions on the healthcare experience exploded in the virtual world, making their way from the web to social media to healthcare mobile apps. Patients began to take notice and used this new crowdsourced information to further refine their healthcare choices. The consumer minded patient has made way for interesting new models. Patients can now order their genetic profiles online. If they feel unwell, they could do a virtual consultation with a doctor and if not happy with the response, get a second opinion from a plethora of other internet sites. If that seems like too much to do, they could even plug in their symptoms into one of many triage sites to get a provisional diagnosis. They can order medicines and diagnostics tests online, and if they need surgery, robotics will ensure their surgeon doesn’t even need to be in the same room as them. Welcome to the world of DIY (Do it Yourself) medicine. Bringing healthcare to your doorsteps, just like a pizza!
Health providers try to keep pace
Healthcare providers, hospitals, clinics and doctors have begun to take notice and started instituting mechanisms to get ahead of this tsunami of public opinion. Most hospitals have now begun “patient education programs” (even if most remain underwhelming) and collecting “patient feedback” is now part of most hospital and clinic processes. I often hear patients being referred to as clients or customers, implying their satisfaction is now one of the more important metrics of care delivery. In the US, patient reimbursements are now linked in part to patient feedback scores. A number of primary healthcare delivery clinics and online counselling startups in India have started offering warranties and money-back guarantees to to patients, dissatisfied with their treatments. These organizations believe treating patients like customers places the right pressure on their systems to demystify and educate patients as well as to deliver on promised outcomes. The Indian government recently started a program called Mera Aspataal (My Hospital) to solicit feedback from patients on their experience at over 145 government hospitals. When I was in medical school, it was important to ensure patients go back healthy. Now it’s important to ensure they go back healthy and happy. You could argue, those two are not always the same thing.
Has Consumerism in Healthcare made a difference?
Patient centricity has unequivocally changed the direction of healthcare in the right direction. Patients and their caregivers are more informed today than they were just 20 years back. They have more data available to make informed healthcare choices. Their feedback to facilities and doctors has begun to change practices and workflows in hospitals. Doctors are communicating more and recognizing they need to play by the rules of the new healthcare marketplace where consumers can ask questions, demand answers and if necessary, vote with their feet. It is very clear that choices offered to consumers across other sectors is beginning to prime their expectations of the healthcare transaction as well. A recent Mckinsey report on healthcare consumerism found that patient expectations will continue being shaped by their experiences from retail, technology and other consumer oriented industries.
Can the system handle the empowered health consumer?
At a system level, the DIY medicine has been great at lowering the barrier for accessing healthcare. This is great for patients, who can now access healthcare advice far more easily and from many more sources than they had access to a decade back. However, far from reducing the burden on the system, this has led to increased burden by unlocking demand that was never accounted for. Suddenly, people are reaching out for symptoms and scheduling virtual visits for conditions they would have ignored 10 years back. They are asking doctors questions they may not have a few years back. Consumer driven rise in demand is great to raise the level of health awareness but does put pressure on the already tight healthcare supply side. It also diverts resources towards populations that have disproportionate access to the online tools while worsening supply for the underserved populations. In other industries, this would represent an opportunity to add new capacity (retailers, banks, cars) in some other form. In healthcare, ramping up the already constrained supply to meet the burgeoning consumer driven demand may not be quite so easy.
Not quite there yet?
As a patient and a caregiver, there’s nothing to lament about the one sided doctor- patient conversations of the past. I do wonder how consumerism in the form we see today may adversely alter healthcare in the long term. Medicine and healthcare is a complex subject for me. It is some science and some art, very often one masquerading as the other. Some of medicine can and must be demystified (we have algorithms for flying planes after all!) but there’s a lot that we don’t know about the human body and medicine. And no amount of consumer pressure can change that overnight.
There are consequences of consumer behavior that we still need to understand. Patients can, and do jump from doctor to doctor, which is great for enabling choice. 72% of patients would be willing to change their doctor if they had been in a relationship less than 2 years, but this may not be in the best interest of their medium term health. Early studies are beginning to point to some interesting effects of the new age healthcare consumer — virtual visits and health information online may lead to over- diagnosis, self-diagnosis, over medication, inappropriate self-titration of medications and many other behaviours, the consequences of which we don’t yet fully understand. Consumerism is leading to a “I want what I pay for” culture, except that its been difficult to define what constitutes patient wants and satisfaction.
Patients themselves remain unclear how to define a good healthcare experience. It could be linked to the cost of your treatment, how painless your experience was, how soon you got back to work, how clean the hospital was, how much time the doctor saw you, how much he/she smiled, how much information you were given before, were there complications during treatment, how much the medicines cost or maybe 20 other clinical and non-clinical outcomes we could define. Or the satisfaction could be linked to something completely different. Many leading hospital systems have instituted protocols to measure the patient experience on a complex interplay of variables. But defining a good healthcare experience is a lot more complex that defining a good plane ride or a hotel stay. So, patients continue to remain frustrated with the mystery of the healthcare experience. No wonder patients are finding there are limits to playing the savvy “customer is king” in healthcare.
At the start line
This essay is about a ship that’s already sailed. There’s no turning back from the increased sense of empowerment that healthcare consumers feel. Millennials, in particular, will continue to power this movement. This is a generation that has grown accustomed to rapid technological change and lives in a world of digital tools and easy to consumer relationships. Millenials constitute the biggest generation in US history, will comprise 64% of India’s workforce and 50% of the global workforce by 2020. They will soon be responsible for most healthcare decisions (for them and their dependents) and will continue to push for the demystification of the healthcare experience. They may feel frustrated by the seeming slow pace of change, but that won’t slow their yearning and zeal for even more consumer orientation.
However, the line from consumerism to improved experiences is not as straight in healthcare as it has been in other industries. There’s plenty of bumps we’ll have to get over. The rise in healthcare consumerism is a starting point, not the end, in redefining healthcare experiences for the future. Plenty of work yet to be done in delivering the healthcare experience our consumers have rightly come to expect.