One of my favorite ASHP meetings is the Leadership Conference in Chicago every October, and this last one was no exception. As usual,
one of the presentations rearranged my mental furniture a bit around the notion of where healthcare is likely to go.
The thing that was new to me was the notion that consumerism in healthcare and population health are not the same thing; indeed they are headed in different directions! As often happens, the notion made complete sense once it was articulated; I just had never really looked at it this way before.
Consumer-based healthcare essentially presumes the presence of a population heavily knowledgeable about, and involved in their healthcare. The natural consequence of such an orientation is that the direction healthcare will take will be largely based on the decisions that patients, as consumers, will take and that patient choice (consumer choice) will drive how healthcare is delivered. Presumably, the healthcare industry needs only to pay attention to the demands of informed consumers to know how best to serve them.
Population health, on the other hand, presumes the "ownership" of (or at least, responsibility for) a large number of patient lives by a healthcare authority, and that the direction of healthcare will be driven by that authority based on their perception of the needs of the population. Presumably, this authority (be it a payer organization, a hospital, a community governing body, or a physician group practice) will know better than the individuals they manage what is good for them.
What they appear to have in common is a need for big data. Beyond that, they couldn't be farther apart in orientation.
I have long maintained that the normalization of our healthcare system would require resolution of a fundamental public schizophrenia around what healthcare is (a public utility - and therefore a right - versus a consumer good - and therefore available to those who could pay for it) but had somehow lost track of the notion that this schizophrenia continued to play out among those who proposed answers to our unsustainably large cost of healthcare.
What complicates this discussion is the presence of a segment of the population that seems to be uninformed about the realities of their health or, being informed, chooses to ignore those realities. This is the segment that continues to smoke in the face of strong evidence of the hazards it creates, that continues to make lifestyle decisions that lead them inexorably to the emergency room, and that treats their bodies like they treat their cars - run them until they break, and then bring them in to get them fixed. If these are among the consumers who will drive the face of our healthcare system, what will it look like?
On the other hand, will population health take us toward the kind of benevolent dictatorship envisioned in the movie Demolition Man where everything "bad for you" is illegal? This is intentional hyperbole, but one cannot avoid the notion that population health, as it is currently described, involves the intentional manipulation of covered individuals toward what the covering authority believes are the most appropriate behaviors. Are we willing to submit to the notion that our healthcare system would allocate care in ways of which we, as individuals, disapproved because the evidence available indicated that it was unlikely to be successful?
I wish I knew the answer. I don't. I note that, in many of the countries where there is a national healthcare system, there is also a thriving tier of private healthcare for those who can afford it.
Interestingly enough, the speaker to whom I refer above indicated that, in his opinion, the answer would be driven by consumer choice and that the baby boomers, who are sitting on top of trillions of potential healthcare dollars, would be the ones to make that choice. He could well be right.
I have my own schizophrenia on the subject. I have often been accused of being somewhere slightly to the right of Genghis Khan, yet have found myself being more and more attracted to a single-payer solution. My wife, who was a physician in the Soviet Union, tells me I don't understand what that will be like. She is probably right as well.
So what do you think?
Dennis A. Tribble, Pharm. D., FASHP
Daytona Beach, FL
DATdoc@aol.com
The opinions expressed herein are my own, and do not necessarily reflect those of my employer or of ASHP.