New Marketplace

We Are All Patients, We Are All Consumers

Article · December 28, 2015

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?

Call for submissions:

Now inviting expert articles, longform articles, and case studies for peer review

Connect

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

Learn More »

More From New Marketplace
30-Day Mortality Rates at Non-Teaching and Major Teaching Hospitals 2013-2014 - value-based care at academic medical centers

What Value-Based Payment Means for Academic Medical Centers

Academic medical centers must become as dedicated to advancing operational and clinical efficiency as they have been to advancing the science of medicine.

Medicare Compared to Private Spending Cumulative Growth 2009-2019 - traditional Medicare coverage

Redesigning Medicare to Work for Everyone

A proposal to improve the Medicare benefit package.

Pronovost04_pullquote payer interoperability data exchange

Promoting Interoperability: Roles for Commercial Payers

Interoperability is a business imperative for enhancing value in health care, and providers and payers must collaboratively meet the demands for data exchange.

Health Care Snapshot - Chinese Health Care and U.S. Health Care

Perspective from the East: Health Care in China

Context is the key to understanding China’s health care system and its emphasis on population health.

GordonWang01_pullquote - digital health care China

Digital Health Care in China: Benefits and Pitfalls

China’s experience offers insights for integrating digital and non-digital health care services.

Dale04_pullquote_disrupting the value-based vs fee-for-service payment model

Disrupting the Payment Model

We should modernize our payment mechanisms to reflect the reality of our digitally enabled lives.

Percentage of Patients Choosing a Reference-Based Pricing Facility for Knee or Hip Replacement Surgery - 2008-2012 - value-based benefit designs

The Evidence for High-Value Benefit Designs

Innovative models are showing promise, but limited transparency and peer-reviewed research hamper expansion.

New Evidence on Stemming Low-Value and Overprescribing - Nudgind Physicians Toward Better Prescribing Practices

New Evidence on Stemming Low-Value Prescribing

New research suggests that deploying strong and surprising messages could help to address overprescribing of opioids and other drugs.

Wang01_pullquote medical devices - medical device innovation in China

Accelerating Medical Device Innovation in China

Promoting collaboration between clinicians, researchers, device-makers, and regulators.

Health Care Costs - Cost Transparency Is the Main Change Needed to Support Patients in Lowering the Cost of Care

Survey Snapshot: Is Transparency the Answer to Rising Health Care Costs?

NEJM Catalyst Insights Council members say that while transparency might be necessary, we have to change the way care is delivered.

Connect

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

Learn More »

Topics

Value Based Care

209 Articles

Rebooting Health Care: An Optimistic Outlook

The U.S. health care system may seem broken, but it’s on its way to greatness,…

Medicare and Medicaid

127 Articles

What Value-Based Payment Means for Academic…

Academic medical centers must become as dedicated to advancing operational and clinical efficiency as they…

What Value-Based Payment Means for Academic…

Academic medical centers must become as dedicated to advancing operational and clinical efficiency as they…

Insights Council

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

Apply Now