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Are Patients Smart Enough To Make Their Own Healthcare Choices?

Posted Oct 02 2008 3:15pm


Stanley Feld M.D.,FACP,MACE

The following comment is from a physician. He brings up important points.

“Your blog of January 13, 2008, raises my concern for an important and critical factor in you’re repair of the healthcare system proposals:”

I have received many questions concerning my proposals to Repair The Healthcare System. I am grateful for the comments. It means people out there are paying attention and thinking.

“Even if you give the patient the right and responsibility to decide on the way to spend his/her healthcare dollar, that patient is relatively uninformed and most cannot make the important choices about their healthcare because he is uninformed.”

People are smarter that many think. An important element missing from other healthcare reform proposals is providing patients with incentives to make informed choices. A second element is teaching patients how to make informed choices.

Presently the healthcare insurance industry makes the choices for the patient. Unfortunately many of those choices are restricting access to care and driving the patients to lowest cost providers. These choices are made for the healthcare insurance company’s benefit and not the patient.

The healthcare insurance companies make their decisions on price not quality of care. Neither the government nor the healthcare insurance industry has defined quality medical care accurately.

At any one time eighty percent of the people are not sick. The urgency to recognize that the healthcare system has a problem is not on their mind. In recent years as the healthcare system has become so dysfunctional, healthcare insurance so expensive and in many cases unavailable, it is becoming a concern to most people. Additionally, with the growth of information on the internet consumers are becoming more aware of the criteria for diagnosis of many chronic diseases along with the most effective treatment and follow-up. Consumers are starting to make their own judgments about their physicians and the quality of care they receive.

We have seen the growth of demand for diabetes education, and intensive diabetes self management. Intensive diabetes education is important in improving the quality of diabetes care. The methodology to create an effective Diabetes Education program is available.

I believe when patients are responsible for their healthcare dollar and there is a financial reward for effective chronic disease management we will see all the facilitator stakeholders respond by competing for these patients healthcare dollar. The infrastructure will be created to teach everyone to be an informed consumer.

The new web based phenomena of social networking will create social networks for specific chronic diseases. These social networks will stimulate an even greater level of informed patient choices. The patient will be able to distinguish between excellent care and mediocre care.

There are many examples on the internet of information that can help consumers make intelligent choices. Fifteen years ago we depended on travel agents to pick the best hotels in different cities. Today we use www.Trip Advisor.com. We not only receive editorial comment on the hotels but reactions from people who stayed at these hotels. Another simple example is Amazon.com. for book reviews.

“ And whose fault is this? Is it the fault of patients themselves, or physicians and other healthcare professionals, or those who own the healthcare insurance business and our legislators.”

Everyone is at fault! It starts with the patients. They have to be responsible to themselves and their disease. Physicians do not get paid to prevent the complications of disease. In our present system they only get paid to fix things. It is against the vested interest of the hospital to keep the patients out of the hospital. If physicians reduced the incidence of coronary artery disease in diabetes mellitus by 50%, hospitals would be in big trouble. The healthcare insurance industry does not pay adequately for preventive services. If all the stakeholders’ vested interests were align for the patient’s benefit we could decrease the cost of healthcare by at least 50%.

When the healthcare insurance industry or government reimburse for preventive services, the payment is not sufficient to motivate physicians to develop an infrastructure for chronic disease management. When consumers own their healthcare dollar and are motivated to spend their healthcare dollar wisely we will see the development of viable diabetes education centers, asthma centers, and other chronic disease management centers. (Focused Factories)

Effective chronic disease management will not only increase the quality of care, it will also decrease the cost of care by decreasing complications of chronic disease.

And who is going to be able to remedy this?

It is going to have to be the consumer. The mechanism will be the ideal medical savings account with patients being responsible for their healthcare dollar and their healthcare. Hospital systems, healthcare insurance companies and physicians practices will be transformed. It is easy to understand that none of the secondary stakeholders wants to give up its power. The changes involve web based real price transparency, an ideal medical savings account, an insurance industry that continues to negotiate price, accurate definitions of quality medical care for specific diseases and patient web based social networking. It is essential that all of this occur at once.

“One must not only empower that consumer but inform him/her. Please address, in your proposals, the solutions for this deficiency, which must precede all others if a system such as you propose is to work.”

I refer you to my review in the Fall of 2007. The healthcare system must work within a new set of comprehensive rules. We simply can not continue to patch the system.

I believe the consumers is not stupid. If he chooses to take advantage of the system he is in reality taking advantage of himself. The overwhelming majority of patients will make the correct choices. They will utilize technologies of the 21st century to help them spend their healthcare dollar wisely.

Neither the Democrats or the Republicans are close with their proposals to repair the healthcare system.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.



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