Consumer-Driven Health Care: The Changing Role of the Patient

Policy Reports | Health

No. 276
Tuesday, May 10, 2005
by Devon M. Herrick, Ph.D.

Executive Summary

The latest trend in health care? Patients are managing their own care. New technologies make it possible. Legislative changes facilitate it. And financial pressures all but require it. Today, for example, patients can:

  • Use the Internet to freely browse medical journals and libraries for information previously available only to professionals at a cost of thousands of dollars.
  • Test children for ear or strep infections at home. Using over-the-counter do-it-yourself diagnostic kits saves unnecessary trips to the doctor.
  • Obtain a battery of more than 50 blood tests for as little as $90 by leaving a blood sample at a commercial testing center.
  • E-mail personal physicians to obtain a diagnosis, rather than making an in-office visit.
  • Use the Internet to have test results evaluated or obtain a second opinion from a Web-based physician.
  • Shop online for lower-cost prescription drugs or over-the-counter equivalents, saving up to 90 percent off the cost of brand name prescriptions.

Nearly half of Americans (45 percent) have some type of chronic condition. Patients with chronic diseases can manage their conditions and control their health care in ways unheard of only a few decades ago. For example, patients with diabetes can be trained to inject insulin, monitor and maintain a log of blood glucose levels, and use the results to adjust their dietary intake, activity levels and medicine doses.

Patients who manage their own care obtain results as good or better than those with standard physician care and can substantially lower health care costs in the process:

  • Asthmatics can use a software package to monitor their condition and transmit the data over the Internet to a physician for evaluation.
  • Patients with hypertension can test themselves and adjust their medications, based on a formula approved by their doctor.

Patients also have new financial incentives to manage their own care. Employers almost everywhere are raising deductibles and increasing copayments — forcing employees to manage more of their own health care dollars whether they want to or not. Health Savings Accounts (HSAs) are additional incentives that let employees (or their employers) deposit tax-free dollars into an account for current or future health care needs. HSAs are now available in principle to 250 million nonelderly Americans. As a result, the number of people with personal health accounts is expected to grow from about one percent of workers (1.5 million) in 2002 to more than 18 million by 2012.

There are legal and regulatory barriers to the fuller development of patient self-management. For instance, many state medical boards find the practice of cyber-medicine unethical if a consultation does not involve face-to-face examinations. Thus, consulting a physician online or getting a second opinion by way of the Internet (especially across state borders) is often difficult — if not illegal.

State and federal laws keep practitioners from paying nominal fees to organizations that schedule patient appointments or refer patients to them. This prevents the emergence of Internet-based medical service brokers similar to Web sites that sell airlines tickets online. It also makes it difficult to create medical auction Web sites (similar to eBay or Yahoo) where physicians compete on price and services.

Consumers also need greater access to drugs therapies over the counter. Unfortunately, the Food and Drug Administration’s (FDA) recent track record of moving medications to the OTC market is decidedly mixed. Over the last two decades, for every drug switched from prescription-only to over-the-counter in the United States, Europeans have switched more than four. This includes Simvastatin, a popular cholesterol reducer, which is available over the counter in Britain (after a short pharmacist consultation) under the brand name Zocor Heart Pro.

If the obstacles to consumer driven health care were removed, health care quality would improve, and rising costs would be better contained.

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