In Our Flawed Healthcare System, Patients Need To Take More

Surveys show that Americans remain dissatisfied with our nation’s deeply flawed healthcare system, largely stemming from a loss of institutional trust, misaligned incentives and poor service. As I’ve explained in great detail before, healthcare disruptors such as big box retailers have taken notice and are seizing on the discontent – making it easier for consumers to get basic services. But with instances of heart disease, diabetes and other serious maladies on the rise, many patients still must interact with their doctor’s office and maybe even a hospital for their care. It’s a complex system to navigate in the best of times but the unwillingness of many legacy players to provide transparency in cost and quality and ensure accountability for health outcomes makes it that much harder. Consumers, who should always be in the driver’s seat when it comes to the quality and cost of their care, need to be more engaged than ever before.

On one hand, optimizing our own individual health is complicated. And because it is we have been socialized to trust the experts. We have been led to believe they will act in our best interest as they make recommendations about our most precious asset – our health and well-being. But unfortunately, this trust has too often been abused. Too many healthcare providers and the delivery institutions they are part of have failed to deliver on some of the most basic implicit and explicit promises they have made to the people they serve.

For starters, too many providers assume that medicine is just too complex – essentially “beyond” the comprehension of most patients/consumers and don’t even try to make it accessible. So “trust us to have your best interest in mind” has become their mantra. On top of this the experience itself is too often less than rewarding. Common practices consumers routinely have come to expect in other areas of commerce are lacking in the doctor’s office and in short supply in larger healthcare systems. Historically, “service” in these settings has notoriously been provider/institution-centric, not patient/consumer-centric. For example, voicemails can’t be left on a phone, and messages or even basic questions often go unanswered. While concern for potential HIPAA violation is often the counter argument, the excuse doesn’t hold water. These frustrations can lead to delayed care or even forgone care. Inscrutable costs and surprise charges add to the gap between expectations and the ‘experience.’ These examples are symptoms of a healthcare delivery model in trouble.

In other parts of our lives, we benefit from a market-based model that is characterized by competition (choice), as well as transparency in both cost and quality. For nearly all economic decisions people make, these are common features, and having access to the information in user friendly terms enables consumers to make choices. It’s true whether one is buying a house, car, or coffee. But not in healthcare. In this sector, consumers typically encounter an apathetic bureaucracy and patients must grapple with a culture of opacity instead of transparency when it comes to the relevance of recommended are, along with its cost, and outcomes.

To get some clarity on this, Numerof & Associates conducted a mystery shopping experiment to see if we could get the data that would enable informed medical decision-making. The full details and analysis can be found in my last book. Taking on the role of potential customers, we called on a host of medical facilities and physician offices to see what information we could gather. We identified some critical deficiencies. First, we could not acquire any concrete information on the out-of-pocket price of various treatments and procedures. Second, no facility was able to discuss medical outcomes in any quantitative manner. When push comes to shove, these are the essential questions that need answering before care can be pursued. The lack of that information makes comparison shopping impossible.

Comparison shopping is an important mechanism because it allows for real competition to occur. Lower cost, improved outcomes, or an enhanced patient experience become key considerations as competitors angle to attract more and more customers. There are already industry exceptions who have embraced this market-based model for a host of reasons. LASIK, cosmetic dentistry, cosmetic surgery and dermatology have been operating under such a model for decades and we’ve seen increases in quality and efficiency as well as lower prices in each of these specialties. Corrective eye surgery for example used to cost around $8,000 and is now around $2,200 per eye.

Other industries with specialties outside of healthcare delivery are also looking to provide value to a system that often treats value as a secondary outcome. Capitalizing on consumer dissatisfaction with the current system, entrepreneurial giants and start-ups in retail are delivering primary care in the same way other goods and services are provided. Amazon, Walmart, and CVS are leading the way by providing alternatives and attempting to provide value for their customers that the legacy providers are not. Clear pricing, convenient hours, and customer-focused staff are key components.

Implicit in the retail market is the understanding that patients can go elsewhere if they find more favorable conditions, and so these companies work hard to create customer-friendly policies and high levels of service that are consistent from location to location. Again, competition is the means while profitability is the motive. More and more nontraditional actors are moving to fill the void created by providers who have done little to stop that migration.

Patients/consumers should be able to have a dialogue with their healthcare providers about the treatments available, the potential outcomes associated with each option, and their related risks and costs, just like they do in other commercial transactions. Accepting the physician’s word isn’t sufficient; consumers should expect evidence to support the recommendations they receive so that they can make an informed choice. That evidence needs to be conveyed in consumer-friendly terms that can be used to weigh the value of alternative options. If consumers become more assertive, providers will have no choice but to do more.

Real reform begins by changing expectations. By doing so, we can introduce more accountability into each transaction between patients and their healthcare providers and set up the conditions needed to get better health at lower cost.

Public and private healthcare delivery organizations have demonstrated time and time again that they would rather not be questioned about the quality of the care they provide. But after years of poor service and other systemic failures and little sign of improvement, consumers are left with little choice but to take matters into their own hands.