The last two decades have seen a shift in the dynamics of doctors’ consultation rooms. Informed patients have begun to push away on the paternalistic ‘I know best for you’ doctors and started demanding more from their healthcare providers. This rise of healthcare consumerism in India follows on the heels of a similar consumer led transformations of the travel, retail and banking industries, amongst others.
At a system level, the DIY medicine has been great at lowering the barrier for accessing healthcare. This is great for patients, who can now access healthcare advice far more easily and from many more sources than they had access to a decade back. However, far from reducing the burden on the system, this has led to increased burden by unlocking demand that was never accounted for. Suddenly, people are reaching out for symptoms and scheduling virtual visits for conditions they would have ignored 10 years back. They are asking doctors questions they may not have a few years back. Consumer driven rise in demand is great to raise the level of health awareness but does put pressure on the already tight healthcare supply side. It also diverts resources towards populations that have disproportionate access to the online tools while worsening supply for the underserved populations. In other industries, this would represent an opportunity to add new capacity (retailers, banks, cars) in some other form. In healthcare, ramping up the already constrained supply to meet the burgeoning consumer driven demand may not be quite so easy.
As a patient and a caregiver, there’s nothing to lament about the one-sided doctor- patient conversations of the past. I do wonder how consumerism in the form we see today may adversely alter healthcare in the long term. Medicine and healthcare is a complex subject for me. It is some science and some art, very often one masquerading as the other. Some of medicine can and must be demystified (we have algorithms for flying planes after all!) but there’s a lot that we don’t know about the human body and medicine. And no amount of consumer pressure can change that overnight.
Facing the realities
There are consequences of consumer behavior that we still need to understand. Patients can, and do jump from doctor to doctor, which is great for enabling choice. 72% of patients would be willing to change their doctor if they had been in a relationship less than 2 years, but this may not be in the best interest of their medium-term health. Early studies are beginning to point to some interesting effects of the new age healthcare consumer – virtual visits and health information online may lead to over- diagnosis, self-diagnosis, over medication, inappropriate self-titration of medications and many other behaviours, the consequences of which we don’t yet fully understand. Consumerism is leading to a “I want what I pay for” culture, except that its been difficult to define what constitutes patient wants and satisfaction.
Patients themselves remain unclear how to define a good healthcare experience. It could be linked to the cost of your treatment, how painless your experience was, how soon you got back to work, how clean the hospital was, how much time the doctor saw you, how much he/she smiled, how much information you were given before, were there complications during treatment, how much the medicines cost or maybe 20 other clinical and non-clinical outcomes we could define. Or the satisfaction could be linked to something completely different. Many leading hospital systems have instituted protocols to measure the patient experience on a complex interplay of variables. But defining a good healthcare experience is a lot more complex that defining a good plane ride or a hotel stay. So, patients continue to remain frustrated with the mystery of the healthcare experience. No wonder patients are finding there are limits to playing the savvy “customer is king” in healthcare.
It’s only just begun!
This essay is about a ship that’s already sailed. There’s no turning back from the increased sense of empowerment that healthcare consumers feel. Millennials, in particular, will continue to power this movement. This is a generation that has grown accustomed to rapid technological change and lives in a world of digital tools and easy to consumer relationships. Millenials constitute the biggest generation in US history, will comprise 64% of India’s workforce and 50% of the global workforce by 2020. They will soon be responsible for most healthcare decisions (for them and their dependents) and will continue to push for the demystification of the healthcare experience. They may feel frustrated by the seeming slow pace of change, but that won’t slow their yearning and zeal for even more consumer orientation.
However, the line from consumerism to improved experiences is not as straight in healthcare as it has been in other industries. There’s plenty of bumps we’ll have to get over. So the journey has only just begun….
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Dr Aakash Ganju is a healthcare consultant and entrepreneur, focused on increasing transparency, access, and convenience to health providers and consumers. He is the CEO of Avegen and lives in Mumbai, India.