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
Shrank02_pullquote IDFS

Effective Consolidation: A Model for Reform Through Payer-Provider Integration

UPMC’s payer-provider partnership integrates real-time data to support improved clinical decision-making and optimizes clinical and financial performance.

Millenson01_pullquote big data analytics SDOH

Big Data on Social Determinants: Improved Health and Unaddressed Privacy Concerns

The use of psychographic data by health systems and health plans could provoke a backlash if not done with patient consent.

Effect of Value-Based Payment Programs on Providers That Serve the Poor

Financial Incentives and Vulnerable Populations — Will Alternative Payment Models Help or Hurt?

Understanding APMs’ potential consequences for vulnerable populations is critical if we wish to maximize benefits and reduce harms.

Example 4-Quadrant Analysis and Price Setting for a Single-Procedure Bundle - Lessons Learned from DRG Implementation

Making Bundled Payments Work: Leveraging the CMS DRG Experience

Given its clout and experience, CMS is uniquely positioned to lead the U.S. health system toward high-value care. Bundled pricing based on real costs, leveraging lessons from DRG implementation, would establish the right types of provider incentives.

Kocher03_pullquote risk-based primary care provider

Opportunities for Risk-Taking Primary Care Providers

Embracing two-sided risk while adopting workflow redesign and reviewing benchmarks is leading to improved clinical and financial outcomes.

The Unrealized Potential of EMRs: Interoperability and the Opportunity for Disruption

NEJM Catalyst hosted clinical and business leaders, along with the originator of “disruptive innovation,” to consider the user frustration, high cost, and lack of interoperability of electronic medical records.

Steven Seltzer Andrew Menard Clayton Christensen Edward Prewitt Electronic Medical Records Roundtable Head Shots

The Unrealized Potential of EMRs: Why They Fall Short and the Unexpected Source of a Solution

NEJM Catalyst hosted clinical and business leaders, along with the originator of “disruptive innovation,” to consider the user frustration, high cost, and lack of interoperability of electronic medical records.

Robert Gavin head shot

Amazon and CVS: Short-Lived Unicorns in Health Care, or Healers of the “Tapeworm”?

Will Amazon–Berkshire Hathaway–JP Morgan and CVS-Aetna change the health care game? To one health care employer purchaser, these announcements feel a lot like Groundhog Day.

Fiona Scott Morton head shot

We Can’t Spend All Our Money on Health Care

We have to think about how much we want to spend on health according to how much it’s worth to us at the margin.

Simplified Chain of Production for Primary Care Services Generating Retail Prescriptions. Solid arrows indicate contractual relationships or ownership, and the dashed arrow indicates referral for prescription.

Does CVS–Aetna Spell the End of Business as Usual?

What might one of the largest mergers in history mean for the health care delivery system?

Connect

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

Learn More »

Topics

Value Based Care

164 Articles

Effective Consolidation: A Model for Reform…

UPMC’s payer-provider partnership integrates real-time data to support improved clinical decision-making and optimizes clinical and…

Effective Consolidation: A Model for Reform…

UPMC’s payer-provider partnership integrates real-time data to support improved clinical decision-making and optimizes clinical and…

Effective Consolidation: A Model for Reform…

UPMC’s payer-provider partnership integrates real-time data to support improved clinical decision-making and optimizes clinical and…

Insights Council

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

Apply Now