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In Healthcare, Nobody Is the Customer—and That’s a Big Problem


Posted by Brian Buntz on July 25, 2012

Healthcare should be in the hands of patients and medical professionals. But that's not the case in the current arrangement in the United States, where patients pay for only about 12 cents of every dollar spent on healthcare. The rest is picked up by third parties—namely insurance companies and the government. 

The former CEO of the University of Maryland Medical Center, Stephen Schimpff, MD also has five decades of experience as a physician.

As a result of this, there are no clear customers in healthcare, says Stephen Schimpff, MD, author of The Future of Medicine who is now the chairman of the Sanovas scientific advisory board. “If you have healthcare insurance through your employer, you may have a small co-pay or a deductible when you go to the doctor, but basically your insurance company is paying the bill,” he explains. “And, as a result of that, if you go to to the doctor and say: ‘look, I really need some more time to discuss these health issues that I have,’ the doctor might say: well, your insurance only pays x number of dollars so I can only afford to spend 10 or 12 minutes with you.”

Contrast that with, say, the retail or hospital sectors, where the customer is empowered and said to be ‘always right.’ In a typical relationship between professionals and clients, the customer maintains a certain amount of control in the relationship. Indeed, this is still often the case where medical care is still paid for 100% out of pocket.

But the typical professional–client in is now rare in the U.S. healthcare system and that is largely because of the nation's reimbursement system, Schimpff says. And as a result of the current system, healthcare insurance has become notoriously expensive compared to other forms of insurance. “When buying collision insurance for your car, you can choose to between a very low deductible or a very high deductible. If you choose to have a high deductible, you are going to have to pay for a minor fender bender,” he says. “But your insurance premium is low.”

This high-deductible model could be used in healthcare to help control costs and reduce waste. Of course there still is a need for third-party reimbursement in paying for expensive treatments such as major surgery, chemotherapy, or a kidney transplant, which would be beyond the reach for most people to pay for out of pocket.

But a high-deductible system would go far in changing the dynamic of many other encounters between doctors and patients—restoring the professional–client relationship that was more common in healthcare decades ago. “In the past, when we took our kid to the pediatrician, we paid at the door. When I went to my primary care doc, I paid at the door,” Schimpff says. “If we convert to a system based on a high-deductible insurance policy, then when we go to the primary care physician, we are basically recreating that professional client relationship,” he adds. “And now you are in the position to say, ‘you know, doc, I would really like to spend a little bit more time with you’ and that can be worked out.’”

Brian Buntz is the editor-at-large at UBM Canon's medical group. Follow him on Twitter at @brian_buntz.


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