Are we ready to replace the word “patient” with “consumer”?

On September 18 I was one of 7 Canadian thought leaders invited by Walrus Talks to give a short talk about the Future of Consumerism in Canada. I was asked to bring a healthcare lens to the consumer theme. Other lenses included the future of retail, payments, Aboriginal commerce, wellness, data ownership, and unchecked consumption’s impact on the earth’s finite resources. Interestingly, McKesson Canada, a major pharmacy and healthcare company, sponsored the evening – signalling that traditional healthcare incumbents are getting smarter about leading our outdated health system towards the future. I welcome this positioning, very much!

In healthcare, we rarely get the chance to see a messy issue from the lens of other sectors of society – so this was a rare treat. We can often better understand our own stuff when we see it from other perspectives. 

Here are a few ideas I put out there in my 7 minute talk.

Consumerism in healthcare does not mean “patient” = “consumer”

The phrase “consumerization of healthcare” has become somewhat ubiquitous in healthcare circles. As have other metaphors applied to the healthcare context – Uber-ization of healthcare, Retail-ization of healthcare, Mall-ification of healthcare, Amazon-ification of healthcare, … the list goes on.

Indeed, these other business models that were pioneered in the retail and consumer goods worlds have been bleeding into healthcare at a measured pace. This is especially the case in the US where major brands like Amazon, Walmart and CVS are bringing retail-like experiences and business models to traditional healthcare services like pharmacy, dentistry, labs, radiology and primary care. Books are now being published that describe and interpret this growing consumerism trend in healthcare. Notably, Dr. Eric Topol’s “The Patient Will See You Now”, and, more recently, Jane Sarasohn-Kahn’s “Health Consuming”.

But, just because there is a consumerization shift happening in healthcare, are we ready to start calling patients consumers? Based on what is happening today in Canada, the answer is a clear “no”. I would liken calling a Canadian patient a consumer, to calling your school-aged children consumers, instead of students or learners. Sure, aspects of education (a largely state-funded public good like healthcare) are responding to a savvy student that behaves like a consumer in many ways; but students in our publicly funded education system are not choosing what and where they learn based on what is in their or their parent’s wallet.

So I opened my Walrus talk by first challenging the use of the word “consumer” interchangeably with the word “patient”. While conceptually I love that many players in healthcare are starting to think of the patient with a more consumer-oriented mindset, it may be a stretch to call patients consumers if we stick to the fundamental definition of a consumer:

The foundational feature of consumerism is one’s use of their purchasing power to make choices about buying products or services for personal, discretionary use. In healthcare – which is largely funded by the state in Canada – there is almost no patient purchasing power. One of my favorite lines that sums up this point with real clarity: “It's hard to be price conscious when you're unconscious”.

So calling patients consumers – in the purest sense of the word, in Canada at least – is neither accurate nor appropriate.

Traditional Healthcare: Patient has very little in common with a consumer

This thesis that consumer does not equal patient can be born out further by looking at other common attributes of a consumer experience compared to a traditional patient experience. The traditional experience is the dominant paradigm today in healthcare, for the fair share of patients (I’d conservatively guess traditional healthcare represents >90% of all patient experiences in Canada). If you track each tenant of a consumer experience (blue circle on Venn diagram), very little overlaps with a patient experience (yellow circle) in today’s Canadian health system:

At this point in my talk, I was suspecting the audience (and sponsor, McKesson Canada) was wondering, “why did we invite her to talk about the Canadian healthcare consumer if the word is an oxymoron?”

The answer -- because healthcare consumerism is indeed evolving in Canada, at a rapid speed. Many core design features and assumptions of the traditional healthcare patient experience are changing as Canadian consumers change. Patients are getting savvier and are demanding more – they have all the information, they are engaged and invested in their health like never before, and they are coming to expect a service experience that matches the great service they are now getting from nearly every other sector they interact with in the 21st century. Further, data is now being generated that shows that delivering health services that meet patients’ values, needs and expectations results in better health outcomes.

(Canadian) Patient 2.0 = Consumer-ish

And so, while we are not yet there in Canada in terms of abandoning the word patient and replacing it with “consumer”, we had better get ready to redesign nearly every facet of healthcare to meet patients where their expectations are with respect to the experience of the services they get from formal, publicly-funded healthcare. Hence, if we examine patient 2.0 in Canada, the Venn diagram of a consumer experience (blue), and a patient experience (yellow) overlaps significantly:

All of the examples in the middle, where the two circles overlap are examples of ways that leading health systems in Canada and globally are starting to rebase around a more consumer-oriented paradigm. For example, in some jurisdictions like Australia, the government offers up to five “packages” of funding available to patients to use to purchase the healthcare services they need, based on their needs. The old paradigm would have had the state deciding what you need, where you’ll get it, how much you’ll get, and which service provider you’ll get it from.

However, despite the strong momentum towards consumer oriented mindsets and care models in healthcare, there are still two fundamental elements of consumerism that are – and will likely always be – absent from medicare in Canada (shown in red on the schematic above):

1.    Orientation – Unlike the excitement of a consumer purchase, we do not choose to become patients as an aspiration.

2.    Price – price is not a basis of choice in state funded healthcare, as price is negotiated by the state. This is a good thing for patients -- a core tenant of Canada’s Medicare Act is that any citizen will have access to medically necessary services irrespective of ability to pay. But it means that we will never be able to have a true consumer model, given price is the key basis of choice of retail consumers.

In Summary: Do Most Patients Really Want to Be Consumers?

I’ve tried to argue here that despite the growing need for traditional healthcare players to deliver a service experience that is more consumer-like in Canada, patients simply are not consumers, nor do they want to be. People who are sick and vulnerable do not want to be empowered to make a whole bunch of life-altering decisions based on criteria of price, quality, etc. Sick people should not have to shop for the care they need. They just want to be cared for. They want an experience that just seems to “work”, and that doesn’t escalate their already fragile situation. They want a healthcare service provider that anticipates and delivers on their needs. The right thing just happens, at the right time, and in the right place. This is what good consumerism in healthcare looks like.

And this is the vision of a consumer experience of home health care that we are aspiring to achieve in our ambitious work at SE Health.

_________________

To see my 7 minute talk on the healthcare consumer, click here; to hear the other 6 speakers from other sectors reflect on the changing Canadian consumer, click here

Credits: some concepts and ideas in this article were inspired and informed by articles and videos by Dr. Sachin Jain, CEO of CareMore Health, and images on the topic captured from MedTwitter.