New Marketplace

We Are All Patients, We Are All Consumers

Article · December 28, 2015

Key Takeaways

Competing visions of a reformed U.S. health care system have delivered, in each iteration for two decades, a blueprint for some version of a market-based solution. The Affordable Care Act with its emphasis on insurance “marketplaces” (a.k.a., exchanges) has set the country firmly on the path to a new paradigm of health care commerce. The idea was that empowered consumers, armed with better tools and transparent information about quality and cost, would make informed purchasing decisions based on personal preferences. And the new health care marketplace would function like . . . a marketplace.

Language has evolved to reflect this market orientation. “Consumers” increasingly has replaced “patients,” and the terms often are used interchangeably, to the dismay of many care providers. Treating care delivery as just another commodity bought by “consumers” and sold by “producers” profoundly misrepresents the nature of our work. It discounts the values of our profession and fails to recognize the ethical constraints and special obligations of clinicians — which are very different from those of a salesperson or stockbroker.

But, of course, defining people as either patients or consumers is a false dichotomy.

In the new marketplace, we are both consumers and patients. We each face a dizzying (and growing) array of options for insurance plans, provider networks, and institutions of care, all with their own financial implications. We are consumers when we make rational decisions about which health insurance to purchase, about tolerating financial risk, and whether the price of discretionary services represents value. And we will all be patients at some point — ill, frightened, in pain — bringing to that experience a very different set of values and needs that must be respected and attended to.

Historically, we assigned responsibility for “consumer” needs to health insurers and payers, and responsibility for “patient” needs to the medical profession. Friction and mutual animosity resulted — with carriers castigating physicians for reckless indifference to costs, and physicians demonizing insurers for insensitivity to patient needs and the unique nature of the physician-patient relationship.

What the new health care marketplace requires of all participants is shared responsibility for the needs and values we bring to our experiences as both consumers and patients. Organizations must respond to consumer needs for affordability, for accountability (on cost, quality, and transparency), and for reducing the complexity that is proliferating in the new marketplace. And we all must respond to patient needs for compassionate care that recognizes the whole person. The true test of emerging models of care delivery and financing will be: Are they are fit for these purposes? Are they up to the task?

New Call for Submissions ­to NEJM Catalyst

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

More From New Marketplace
Birkmeyer02_pullquote - national physician practices NPPs

Aggregators, Innovators, and the Resurgence of National Physician Practices

A perspective on the growth of NPPs and the ideological divide between for-profit and nonprofit providers.

Hospital-based ACOs Key Capabilities Are Different Based on Level of Risk

Hospital-based ACOs Face Challenges in Tracking Performance Indicators

A focus on bundled payments for specific episodes of care — versus the broad changes required in an ACO model — may be a more effective method for ACO participants to develop capabilities required to measure utilization, cost, and revenue metrics.

Medicaid Referral to Specialist by the Numbers without eConsults

Can eConsults Save Medicaid?

How eConsults unlock medical expertise for the underserved.

Transparency Can Improve Both Quality and Cost of Care

Survey Snapshot: Seeing Progress in Transparency, but the Quest for Value Continues

NEJM Catalyst Insights Council members agree that despite the challenges and caveats, transparency efforts are essential.

Growth in alternative payment models shared savings shared risk bundled payments population-based payments

The State of the Evidence on Payment Reform

Despite some successes among the many efforts to execute value-oriented payment models, the lack of rigorous independent research studies impedes robust progress.

University of Utah Health Buzz Survey Report Cost of Care and Physician Responsibility Out-of-Pocket Costs

Buzz Survey Report: Cost of Care and Physician Responsibility

An independent NEJM Catalyst report sponsored by University of Utah Health on how practicing clinicians and health care leaders view health care costs.

Donald Berwick Melinda Buntin Patrick Conway Raymond Vara Edward Prewitt head shots IHI forum panel on health care policy

Signal or Noise? Navigating Health Care Policy — Part 2

A discussion from the Institute for Healthcare Improvement National Forum. Part 2 of a two-part series.

Transparency Initiatives Are Maturing But Have Far to Go

New Marketplace Survey: A Slow Path to Transparency for Patients

There is national momentum to empower patients with actionable health care information. But how well is the health care industry faring with this push to improve patient-facing transparency?

Donald Berwick Melinda Buntin Patrick Conway Raymond Vara Edward Prewitt head shots IHI forum panel on health care policy

Signal or Noise? Navigating Health Care Policy — Part 1

A discussion from the Institute for Healthcare Improvement National Forum. Part 1 of a two-part series.

Union Square Family Health Evolving Clinic Schedule - after integrated practice unit changes

Leveraging IPU Principles in Primary Care

How a safety-net clinic reorganized into multidisciplinary teams and restructured clinic flow to improve both efficiency and continuity of patient care.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Aggregators, Innovators, and the Resurgence of…

A perspective on the growth of NPPs and the ideological divide between for-profit and nonprofit…

Bundled Payments

51 Articles

Hospital-based ACOs Face Challenges in Tracking…

A focus on bundled payments for specific episodes of care — versus the broad changes…

Survey Snapshot: Seeing Progress in Transparency,…

NEJM Catalyst Insights Council members agree that despite the challenges and caveats, transparency efforts are…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now