Conventional wisdom says that one of the problems with health care is that patients do not have a real stake in the cost of care. That is, either employers assume most of the cost or the third-party insurer paying the bills does. Patients may complain about premiums, but that is only a partial reflection of costs, especially for a given individual who may incur health care charges many times the annual premium.
Our current approach to this problem is to turn patients into consumers. The idea being that a higher stake in costs will cause individuals to shop for health care as they do other products and services. Employers have bought into this concept big time by raising deductibles and introducing so-called consumer-driven health plans requiring a high level of cost sharing before health insurance coverage kicks in. Early research indicates this has some effect on patient spending, but mostly in lost cost discretionary areas such as with generic drugs and perhaps a visit to the ER.
The idea that the patient should have a stake and concern for costs is clearly valid. However, to make this truly effective we need a new paradigm. It is not the patient who must change. Rather, we should leverage the patient’s involvement in cost sharing to more effectively implement important changes to the health care delivery system.
Call it what you will, what we really need is better coordinated, managed care. It may be in the form of Accountable Care Organizations, HMOs, Medical Homes or even greater emphasis on the role of the primary care physician. In other words, rather than trying to make patients consumers within an uncoordinated system thus perpetuating such inefficient care, use reasonable levels of cost sharing to gain acceptance of the changes needed to manage costs AND improve the efficiency and quality of health care . Make the patient an integral part of the delivery system because he or she wants to be as opposed to focusing the patient on costs within a system that still provides incentives to provide more care and spend more money. To do otherwise is simply cost shifting.