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

Now inviting longform articles

Connect

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

Learn More »

More From New Marketplace
Three-Part Pricing of PCSK9 Inhibitors

A New Model for Pricing Drugs of Uncertain Efficacy

Are we paying too much for new drugs before we know how well they work? This innovative pricing model proposes postponing major rewards until efficacy is established — which could help both patients and payers while still paying back investments on the most effective drugs.

what does quality measurement in health care mean

Buzz Survey Report: Addressing the Problems of Quality Measurement

An independent NEJM Catalyst report sponsored by University of Utah Health on patient involvement in quality measurement.

Average HOOS and Average KOOS for patients undergoing hip and knee replacement at CJRI

Building a “Hospital-within-Hospital” Model for Joint Replacements

The Connecticut Joint Replacement Institute has demonstrated that formerly competing independent providers can unite on a common vision to yield drastic improvements in quality, safety, and costs.

Discharge Rates and Follow-Up Internval Dashboard for One Provider at MGH Dermatology

A Successful Pilot to Improve Access by Adjusting Discharge and Follow-Up Rates

Actionable data and modest financial incentives can help motivate clinicians to adjust their behavior around scheduling follow-up appointments.

Cautious Optimism That Value-Based Reimbursement Will Become Primary Revenue Model

Survey Snapshot: What Would Accelerate the Adoption of Value-Based Care?

NEJM Catalyst Insights Council members weigh in on the barriers and path forward to value-based health care.

Strongwater08_pullquote primary care value proposition and disruptive innovation

The Evolution of Primary Care: Embracing Innovation While Protecting the Core Value

Primary care must leverage disruptive innovations to ensure that patients receive first-access, comprehensive, coordinated, continuous care that is woven into a seamlessly integrated system.

Berns01_pullquote nephrologists dialysis facility joint venture conflicts of interest

Dialysis-Facility Joint-Venture Ownership — Hidden Conflicts of Interest

Despite potential benefits, joint ventures between nephrologists and dialysis companies raise legal and ethical concerns because of participants’ conflicts of interest and lack of transparency.

Fee-for-Service Continues to Account for the Majority of Revenue

New Marketplace Survey: Transitioning Payment Models: Fee-for-Service to Value-Based Care

In a survey of the NEJM Catalyst Insights Council sponsored by Optum, respondents express enthusiasm for value-based care but have conflicting opinions about just how far along that path they should go.

Sample Report Comparing Individual Patient-Reported Outcome Measures with FORCE-TJR National Norms

The Essential Role of Patient-Centered Registries in an Era of Electronic Health Records

Smartly designed patient-centered registries capture longitudinal data to augment EHRs and enhance quality improvement, policy, and research efforts.

Murray02_pullquote surgical care bundled payments accountable care organizations

Surgical Value — Beyond Bundled Payments

The surgeon has a crucial role in defining value for patients in a population — and not just when that patient is in need of the surgeon’s knife.

Connect

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

Learn More »

Topics

Value Based Care

194 Articles

A New Model for Pricing Drugs…

Are we paying too much for new drugs before we know how well they work?…

A Venn Diagram for Health Care…

A simple road map for health care organizations to follow when working through integration, which…

A Venn Diagram for Health Care…

A simple road map for health care organizations to follow when working through integration, which…

Insights Council

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

Apply Now