Friday, April 22, 2011

Paul Krugman: Patients Are Not Consumers

Paul Krugman writes:

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.
What has gone wrong with us?

More here.

Consumer Driven Health Care advocates legitimately point out that health care's supply-driven economics insulate patients from costs and thereby increase them. However, CDHC counts on a degree of health literacy that isn't possible under the best of circumstances, and the United States doesn't have the best of circumstances. For example, patients rarely have access to care outside of their insurance plan, meaning that quality and competition is subject to financial penalty. Moreover, there are no standards with which patients can compare costs and quality, and even if there were, there's no way to access them.

Negotiating the U.S. health care apparatus is a daunting task for medical professionals. How can people facing potentially mortal conditions be expected to do it?


  1. Tomorrow, I go into the hospital for my second hip replacement in less than five months. I've got to tell you, I did not shop around for a surgeon, an anesthesiologist, nursing care, orthopedic prostheses, or even the food I'll eat during recovery. I'm not even sure how one would go about some of that. And, I'm not 80 or 90 and incapacitated, so probably could do the research, if necessary. Instead, I'm following my rheumatologist's advice on who should do the carpentry, and I go where he goes. Yes, I'm a patient, not a consumer and happy to turn over my care to the experts. Medical care never was a comparison-shopping project, and never should be.

  2. The argument that health care is just another good or service implies that the stakes are no higher than purchasing a car or a television. Virtually no one facing major surgery will share that perspective.

    The counterargument depicts Lasik surgery as somehow representative of all procedures. However, Lasik is elective, has little risk, and is essentially a matter of vanity. Nothing about that describes hip replacement.

  3. I think the idea of using a product is what makes you a consumer. Interestingly, I had my fair share of knowing what hip replacement is all about when my grandpa had his hips replaced. Paula's point represents what most patients are doing. You trust someone to sort out things that you aren't really knowledgeable enough. Unfortunately, the depuy asr recall going on is a bit disturbing. What's your take about this issue?

  4. Tim, sounds like you have a career path ahead of you!

    For my money, medical care is the exception to the rule about product use defining consumerism. The greater the stakes, the more patients will rely on the referrals of trusted physicians. Also, the typical tools of determining consumption don't exist in medicine. There are no standards to define outcomes, and meaningful scorecards of hospital and physician performance are few and far between. Also, most people find the cost of going outside of plan to be prohibitive, so their choice is automatically constrained.

    You may find this web site interesting:

    You can even look up hip replacements!