Health Care Consumers
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Earlier this year, the Deloitte Center for Health Solutions published a survey of health care consumers that covers a lot of ground. In fact, I would recommend it to anyone who’s interested in learning about what’s on consumers’ minds these days. The report itself is quite long, so I won’t try to capture everything it says here, but it does make some important points that are worth repeating.
First, the health care consumer is not monolithic. He or she is a bunch of different types of people - with very different views of the system, and how to approach it. Deloitte breaks the consumer up into six categories…
1) Content and Compliant (29%) - While not regular users of the system, these folks do what they’re told by their physician, have a traditional view of how the system works and what their role in it should be, and are more satisfied than most with how it works.
2) Casual and Cautious (28%) - Not terribly engaged with the system - mostly healthy, and pretty low users of it - not particularly impressed, or unimpressed, with how it works.
3) Sick and Savvy (24%) - Highest users of the system, smart about how it works, and generally speaking, pretty satisfied with how it works for them.
4) Out and About (9%) - Medium users of the system - not committed to traditional care delivery models, willing to try alternatives, and not all that satisfied with the status quo.
5) Online & Onboard (8%) - High users, willing to think “outside the box” on care delivery, heavy users of online tools to chase down data - reasonably satisfied with the way it works for them.
6) Shop & Save (2%) - Sporadic users, price/value sensitive, and willing to modify usage patterns to save a few bucks.
While I wouldn’t necessarily break the consuming public up along these lines, I think the larger notion - that the health care consumer represents a multitude of approaches and points of view - is exactly right. More importantly, many of these folks - in this case, well over 60% - are pretty happy with the way things work now, and aren’t jumping on the bandwagon to throw out the baby or the bathwater. This makes wholesale change a tough sell.
Deloitte also points out that in some cases, what consumers say they want and what they say they did - or do - is not always the same. Aspirational beliefs and practical acts can vary in health care a bit - more so than in other areas. Add to this mosaic the fact that most of these people get their health insurance through their employer - and that their employer’s approach could vary dramatically, depending on the size and nature of the company they work for - and figuring out what moves people and why gets extremely complex.
In short, the health care consumer should be understood the same way we understand other consumers - not one size fits all, and interested, more often than not, in many different notions of what constitutes what’s right for him, for her, or their respective families.
Makes this whole reform thing a bit more complicated, no?
NO! It is only complicated because the payers and providers insist on making it so, thereby ensuring that the status quo remains intact.
As replies to questionnaires, Deloitte’s findings did not surprise me. Did they you? This is how everyday conversations about health care sort of break down. Still, my nagging suspicion is that we, in all our factions, do not know our own minds when it comes to health care since it deals with pain and suffering and sickness unto death, not to mention itches and ennui — and our authorities are so riotously righteously cacophonous. So, such surveys strike me as exercises in “How do I know what I think until I see way I say?” and then, “How do you know what I say is true until you see what I do?” Even then, I am likely to change my mind.
Of greater moment is how to orchestrate evidence-based health care when the journal articles come so fast and furious that no sub specialist can keep up with her own, let alone those of all the other sub specialists. How do you keep medicine from becoming a Tower of Babel pinball machine, and patients the pinballs? And what’s a generalist, i.e. primary care physician, supposed to do? How do the clinicians militant help a patient work his way through a diagnostic decision tree to the right treatments for him — when everything in medicine is freighted with probabilities, trade-offs and side effects that shift like Hogwarts’ staircases depending on the morbidities you happen to have? Remember, our most expensive folks tend to have several.
Just because for every action there’s a reaction and nothing in life is certain but death and taxes, our priests of medicine do have explaining to do to internet savvy consumers (us) who should have a say, perhaps the final say, in our own care. Our culture is moving that way so sayeth Deloitte and just about everyone else. Health care should be wired up, clinicians and patients hip and joined at the hip on line, so sayeth Gates and Google. We do have an emerging consensus on pretty significant matters. Still, the pros have work to do to fashion a user-friendly interface for the burgeoning tool kit of medicine, and we the consumers have work to do too. Being deft with a mouse doesn’t make us savvy; what makes us savvy is knowing how science works — rules of evidence, scientific method etc, and what science yields — probabilities not certitudes — and that all health care is a balancing act that works a whole lot better if we work to stay healthy. Today’s health care disorients us, some of us more than others. For us to get our bearings, this industry must clarify, which in fits and starts it appears to be doing. Once it gets there, we’ll all have a better idea of what we think and what we want.