What Do Patients Want?

Let me ask you a question. If you can answer it, you are on your way to success in the quest to satisfy the demands of the healthcare consumer. Here is the question; “What more do patients want?” We have extended our hours, lowered costs and made them more transparent, placed doctor’s private information like medical board sanctions on the Internet, and given patients informed consent. What more do they want?

I had to ask myself this last week when I was practicing emergency medicine in a large tertiary care center. I had a patient in the exam room and who I had already examined keep calling 911 from his exam room. He called them three times! Finally, the 911 operator called and asked us to please take care of this guy or at least take his phone away. When I asked the patient about it, he said, “You’re not taking care of me fast enough, and I want a pizza!”

Immediate care centers are on the absolute forefront of healthcare consumerism. In his autobiography, “My Years at GM,” Alfred Sloan had this to say: “There has to be this pioneer, the individual who has the courage, the ambition to overcome the obstacles that always develop when one tries to do something worthwhile, especially when it is new and different.”

It’s an understatement to say that healthcare in the United States is in a state of flux. Whether one looks at the science, the policy, the economics, the ethics or the business of medicine, we are witnessing a sea-change like we never have in the past. Most of these trends are affected by the vast number of people needing ever increasing modes of treatment.

For this article, I am going to limit the discussion to addressing the needs of the individual. Before we get to that point, however, we need to review how we arrived at this mess in the first place.

How did we get here?

This crisis first started in the late 1940s and 1950s as a private, employer-based health insurance which paid hospitals and providers a “reasonable cost” for the services they provided. This system gave providers and hospitals little incentive to even consider the cost of the care they were providing. In fact, it probably promoted unnecessary care. As long as the insurers were able to pass the cost of the premium on to the employer who in turn passed it on to the consumer by raising the price of their product or service the system went unchecked. In addition, during this time, government tax policy subsidized generous employer-provided health insurance coverage. These factors allowed two things to happen:

Consumers were insulated from the real cost of their healthcare.

Consumers focused on what benefits they were entitled to from their employer and not on the cost of their care.

Thus, the people who were making the purchasing decisions, namely patients and physicians, had little or no reason to consider the costs of these services because it seemed, at least to that group, that they were paying with someone else’s money. As we now realize, this financing scheme was not sustainable. Healthcare spending continues to rise at a rate far in excess of general inflation, consuming an ever-increasing portion of our nation’s resources.

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