U.S. health care in conflict — part II: the challenges of balancing cost quality and access - Policy - consumers and insurers negatively affecting health care industry

Physician Executive, Sept-Oct, 2002 by Mary L. Dombovy

MANY HEALTH CARE consumers of the 21st century are becoming more demanding of their providers as they are actively involved in making choices about the health care they receive.

Three characteristics distinguish these "new" consumers from traditional consumers of health care services:

1. Cash

2. College

3. Computers (1)

First, the increased level of disposable income creates the opportunity for discretion in purchasing. Consumers can choose between a more expensive health plan that offers choice in physicians or extended services or decide on alternative medicine approaches. Conversely, they can skimp on health care and purchase a new car.

Second, over 50 percent of the population will have some college education, and as a result, take a more analytical approach to purchases, health care included. They will seek information on health care services and issues from a variety of sources and bring that information to bear in discussions with their providers about alternatives in treatment.

Third, access to computers and the Internet will allow consumers to view, collect and compare reams of information with relative ease. Service delivery in medicine currently includes:

* The office visit

* Process of diagnosis

* Referral

* The operation

All of these are hundred-year-old ideas that have changed little despite new information and medical technology.

Consumer expectations of health care providers' level of service is now being shaped by their experiences with retailers and financial services firms, who are competing for their discretionary dollar. The ease of use of the telephone and Internet for shopping and other transactions adds to their expectations of easy access, as well as accommodating and high quality service.

The "new" consumer expects free choice of doctors, hassle-free appointment scheduling, control over types of treatment received and access both in person and online to information about their health and health care services. Currently, most health care providers treat patients as products, not customers, an approach that is likely to be forced to change.

Of considerable concern, nearly 40 percent of the population is not in the highly educated, cash-available group with access to computers. These consumers tend to be the same inner city or rural residents, immigrants and elderly who are already underserved and underinsured. This situation could foster more tiers in the health care system.

As consumers are being pushed into being the payers for more of their health care, they are likely to select from options very different from those offered in the past. The Internet and other information technology offer the promise of revolutionizing both the business and service delivery components of health care.

Besides accessing health care information, information technology will allow consumers to purchase drugs, health insurance and other health items on line, as well as view portions of their medical records, bills and interact with their physicians.

On the provider side, access to research data, integration of clinical and payment functions, electronic medical records, electronic automatic purchasing and scheduling will lead to error reduction, process efficiencies, the ability to access information from multiple sites and enhanced disease management.

Telemedicine has the potential to lead to delivery of medical services and monitoring of patients in remote sites. The Internet and telemedicine together should be considered disruptive technology--advances that make information, transactions and services available in the home and other sites that were formerly accessible in only limited locations.

Add in the rapid advances in medical technology and pharmaceuticals, and the stage is set for dramatic changes in the health care delivery system. Although advances in information technology, pharmaceuticals, genetics and other medical technology are likely to have an impact on basic health care services, they also carry the concerns of increased cost, and in the case of genetics, the potential for exclusion from coverage and numerous other ethical issues.

Americans' desire for the latest and best technology defies logic and reason. Limiting the use of evolving new and unproven technologies and drugs will prove a difficult task, let alone deciding how they will be paid for when they are deemed appropriate.

The health care system is slow to change, and in a time of scarce financial resources for many providers and no enhanced reimbursement for technology investments--not to mention the threat posed by much of this technology to the physicians--implementation of these services continues to lag behind the available technology.

The United States economy is undergoing a fundamental shift, and with that shift comes changes in the way income and wealth are created, accumulated, distributed and used.

Flower, in an interview with health care futurist Stan [Davis.sup.2] notes that Davis postulates that the changing economy will accelerate the transition from "sick care" to managed care to true "health care," where prediction, prevention and education predominate.