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We Are All Health Care Consumers Now

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VEGETATIVE STATE AWARE
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In 1997, sociologist Nathan Glazer declared, "we are all multiculturalists now." By this he meant that the so-called "melting pot" had dissolved as a binding construct for Americans; multiculturalism had displaced assimilation.

We are at a similar moment of reckoning in Canadian health care. While there remains a (small) tenacious opposition to consumerism, the force of that opposition is waning. Those who object to calling Canadian taxpayers "consumers" of health care presumably prefer the passivity signified in the anachronism, "patient."

Support for consumerism -- and the related principles of accountability for dollars spent, public report cards, involvement in decision-making, and Four Seasons-style service expectations -- crosses political lines. Most health care observers of left and right pedigree in this country today see citizens as consumers, and argue in favour of principles of hospital transparency for such things as wait times for clinical services, or surgical complication rates. Every province professes to champion "management for results" in health care -- a principle legally and culturally entrenched long ago in the private sector, and one that Peter Drucker first sold as an essential management tool in 1954.

To be sure, the country is still divided over the right funding mechanism for health care. While out-of-pocket expenses for health care are a (growing) reality across the country, and no less than our Supreme Court has suggested that a prohibition on private insurance for medically necessary services is unconstitutional, public opinion polling reveals that the country wavers on the state's proper role in health care delivery. But the debate over health care consumerism -- a more overarching issue bound up in the very notion of Canadianism -- is over. Outside of dusty corners of academia, Canadians agree that health care is a service industry like any other. It's just more complicated.

The case against consumerism is that it doesn't make consumers smarter. Even highly educated consumers do not use performance report cards intelligently. (Bill Clinton failed to go to the top-rated facility for his quadruple bypass surgery in 2004). Ranking of hospitals, the anti-consumerists will tell you, is statistically unsound -- in part, because it jumbles together diverse performance measures that cannot be aggregated, or it mistakenly suggests that statistical differences in outcomes cannot be explained by some other variable, such as the age profile, education or acuity level of the population served.

There is merit to each one of these arguments, but they miss the real point of consumerism as it is increasingly understood by Canadians and people around the world. Consumerism can mean different things to different people; Karl Marx saw consumerism as government policy that encourages excess or ill-informed consumption of capital goods. The libertarian right tends to use consumerism as a policy rationale to wrest demands for more choice and control over how to pay for health care. Another view has it that consumerism is an unstoppable force, driven not by government but by an aggrieved public, advocating for the proactive protection of the consumer against lousy, confusing or dangerous products and services, misleading advertising, and unfair pricing.

No matter who is paying for health care, these complaints are serious and deserve fair hearing. The evolution toward a future of more assertive, empowered and value-driven health care consumers is a global and irreversible phenomenon precipitated by escalating costs in the provision of care (linked, in part, to a proliferation of unhealthy behaviours including poor diet and physical inactivity), shifting demographics and an aging population, and by a shift to social media as a powerful tool of communication.

Today, the information and evaluative tools that will guide consumers to this future state are in their beginning stages. Most Canadian consumers have no clue as to what their health care truly costs -- they see it as "free" or "prepaid." This will change. Early U.S. consumer product reports were fringe publications. It took a generation for consumers to grab the information and use it to make buying decisions. Today, Consumer Reports has over 7 million subscribers. Early lawsuits launched against product reviews have forced the maintenance of rigorous evaluation methodologies of products and companies.

Today, the growing Canadian consumer revolution in health care is palpable. We now have "mini medical schools" for consumers at many medical programs across Canada. In Canada, independent research bodies now separately produce comparative hospital performance data on clinical and financial outcomes, system integration, and consumer satisfaction levels. (One set of data can be downloaded from the Web at www.hospitalreport.ca; the other, at www.hospitalreportcards.ca). A "navigator program" in Nova Scotia guides cancer consumers and their families through the maze of cancer interventions. Self-care programs, such as Calgary Health Region's Row Your Own Boat Program, are springing up across the country, targeting people in early stages of chronic disease, and focusing on wellness, monitoring, nutrition, and exercise.

As Regina Herzlinger observed in Harvard Business Review, "Patients, after all, are like other consumers: They want not only a good product -- quality care at a good price -- but also ease of use." It should be clear: We are all health care consumers now. When I step under a surgeon's knife, I feel a lot better knowing that she faces public scrutiny and accountability controls well before the malpractice lawyers get involved.

I suspect you do, too.

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