Patients as Health Care Consumers - Essay Example

? Patients as Health Care Consumers Patients as Health Care Consumers Introduction The concept of consumerism was initially applied United Kingdom’s health care users between late 1970s and early 1980s. This was upon introduction, by the then conservative government, of policies a number of policies based on consumerist requirements. Health care consumer refers to any potential or actual recipient of health care and health services. This is more or less the same as the case of a consumer who is any individual who purchases products or services for the intent of personal use and not for resale or manufacture (Thorogood 1992:28). Like a consumer who makes decisions on whether to buy a commodity or not in a given store, so is a health care consumer who can be influenced by advertisements and marketing. Health care consumers include patients in any hospital setting, a client in a mental health centre within any given community, or it can also be any person who is a member to any organization providing prepaid health care services and maintain (Ryan et al 2009:78). At any given time that a person decides to visit a health facility for any kind of health or medical attention, she or he makes the decision of doing so as a health care consumer. Through health care consumerism, the conservative government is deemed to have introduced monetary structures of Britain’s National Health Service (NHS) and Community Care Act both of which had their aims inclined to increasing competition as well as shift in NHS’ culture. This was in regard to concerns of minding patients as health care consumers and it involved shift from a culture that was established through decisions and preferences to a culture that was determined by health care users’ wishes and views. Wolfe (1971:528) observes that “the Labour government, which came to power in the year 1997, shifted emphasis and efforts of National Health Service (NHS) from competition to partnership and cooperation, while still reflecting consumerist principles. A key element of labour policies has been involving users and local people in decision making, mainly through communication and consultation”. An instance of considerations on health care consumerism is when the government introduced overall management in NHS in the year 1983 at various levels of service so as to research on the needs of patients alongside their views regarding quality of health care. Following these and other essential considerations, consumer driven health care has been on the rise based on the need to get health care consumers satisfied being that they form the basis of health care industry by purchasing health care services and products (Natalier and Willis 2008:407). This paper attempts to look into issues regarding the view that patients are consumers of health care services. Mechanisms for Consumerism in Health Care There are some mechanisms for consumerism in health care which have continually been exhibited in as much as health care consumerism has been embraced. One of the mechanisms is Patient Charter which is actually a document of the United Kingdom’s government with a layout of rights for NHS patients. This charter has been into force since its inception in the year 1992 through Conservative government but had been revised in the years 1995 and 1997. According to Adeoye and Bozic (2007:97), “the charter sets out rights in service areas including general practice, hospital treatment, community treatment, ambulance, dental, optical, pharmaceutical and maternity. However, various stakeholders have criticized the charter for reasons widely ranging from not offering sufficient support to trans-gender patients to increasing attacks on hospital staff”. Amid the issues, the charter has been meant to be legally binding as far as health care consumerism is concerned. Another mechanism for health care consumerism is Choose and Book approach which has been applied since the year 2005. This is an electronic booking software system cum application which health care consumers have been presented with through National Health Service to allow them make choices of hospitals they can be referred to by general medical practitioners. This mainly applies to outpatients who also book appointment dates and time which they deem are convenient to them. Since patients form the basis of health care following the fact that they are the consumers, timely and high quality medical services is their priority (Roter 2009:13). The system enables patients to choose their preferred hospitals and/or health care facilities for their treatment. This is attributed to the fact that there are specific hospitals which offer and specialize in particular health care services depending on treatments implied. There is also NHS Direct mechanism which entails health information and advice services as offered by the National Health Service (NHS) for both residents and visitors in the United Kingdom all round the clock. This is based on checking on symptoms through phone calls via a national line contact, website as well as via a mobile number. “As a part of the National Health Service, NHS Direct services are free, although the 0845 number is charged at a national rate from a BT landline. The website remains free, including call backs. Users of the service, through whichever channel, are asked questions about their symptoms or problem” (Black and Gruen 2005:283). There are common disorders which are usually accorded simplified health care advice which can be followed so as to prevent usage of expenses that might be unnecessarily incurred by visiting health care facilities or professionals. However, there are cases of more complicated problems which call for nurses to assess and provide treatment information and advice or rather makes referral to another health care service provider which is affiliated to NHS. Apart from the already mentioned mechanism for health care consumerism, there is also personal budgeting by individuals. This has especially been contributed by the government’s commitments and efforts to increase people’s choices and control on the basis of long term circumstances thereby they get to have personal care while at the same time addressing their need for personalized and tailored provision for health care services. Personal health care budgets have been one crucial mechanism which has assisted personalized health care within long term conditions such as diabetes (Lupton 1997:378). This has mostly been the case in attempts to enable making choices as far as self care support and interventions are concerned in terms of health care systems. However, a few people wish to use individual budget mechanism for health care consumerism and provision of health care services on the basis of long term conditions. The Patient as a Consumer There are a number of reforms in the health care sector which are being considered following needs of patients being that they form the basis of health care systems. Health care delivery and services have also been in the verge of changing following dire economic pressures and this has influenced the environment of health care with regard to patients who are the sector’s consumers (Andrews 2002: 351). Health care sector is made up of no other consumers but patients therefore, care has continually been offered to them especially through organizations focusing on care. The organizations which are mostly referred to as Accountable Care Organizations (ACOs) have been charged with initiative of affiliating health care providers and institutions such as nursing homes, hospitals, treatment centres, rehabilitation facilities and outpatient diagnostic among others. Patients are also the basis of insurance companies’ operations which are associated to coverage of thousands of lives singly (Sharma 1995). Following these, patients have rendered ACOs competing for consumers especially those with high health care utilization. Patients, therefore, form the core of health care sector since their absence will only lead no players in the health care environment. There have been increased doctor-patient relationships following the need for patients to gain access to one on one health care service. This is mostly attributed to the fact that patients who are the consumers in the sector have preference for personal loyalty to medical practitioners hence, making economics to be controlled by health care provider choices. There have been trends of patients opting to shop for their personal health insurance coverage. Zakus and Lysack (1998) point out that “patients being consumers will greatly lead to competition among insurance companies for patients, though one consequence will be the failure of all but the largest of carriers who will survive in that market.  In addition, the competition will likely be for the low risk population and not those that need healthcare the most”. Besides, they patients have already contributed to large health care facilities diversifying their medical services and enterprises rather than focus on insurance coverage provisions. Rudzik (2003:247) notes one of the influences of this as having been the fact that most medical practitioners especially physicians are owned by health care facilities alongside concerns to provide direct health care to the patients. Continuation of the same may eventually phase out usual relationships between patients and doctors. Being that patients are regarded as the main health care consumers in the health care sector, system of consumer driven health care has become a routine which renders the patients having control of their own personal budget on their health issues (Frank 2002). This is due to the fact the patients are the key decision makers as far as health care services they receive are concerned. However, there have been claims that consumer driven health care has potential to make health care consumers especially patients from humble backgrounds and less educated not to obtain recommended and appropriate care following high health care costs (Ryan et al 2009:65). Also related to this is the fact that they are incapable of making good choices as far as health care is concerned. Implications in Healthcare and Effects on the Goal of Placing Patients at the Centre There have been some implications in the health care sector as far as it is consumer driven. One of the implications that are associated with the health care in the United Kingdom is that more concern is placed on money rather that health or health care as should be. Following this, there have been a number of escalations relating to health care costs. This has had adverse impacts on a number of aspects regarding health care in the country and even in other countries as well (Andrews 2002: 343). This has led to a more difficult implication of increased health care costs. Health care costs have been on the increase yet the consumers do not figure out value placed on the services they receive with respect to amount of money they part with. Another pertinent issue regarding health care is that there have been claims about poor or low standardized health care services from health care facilities, practitioners and providers as well. Most of the service providers have not been concerned about the services being provided from their health care facilities while at the same time most of the equipment being used are outdated yet they persist on receiving fees at non-proportional rates. Black and Gruen (2005:283) argue that “due to the decreases in reimbursements for medical care, physicians find it necessary to see more patients in their day, leaving less time for each. Patients feel as if they don't have time to talk to their doctors or ask questions. Providers know they must rush through appointments”. Following frustrations that come with such occurrence, as well as from cases of low staffing hence inappropriate ratios of patient to doctor, health care consumers have been dissatisfied most of the time (Roter 2009:7). This has also resulted into uncertainties amongst health care providers especially with consideration that health care costs have been high and cannot be properly equated to the services provided and conditions within health care facilities. Another crucial issue that has been a basis of implications in the health care sector is the fact that there has not been heightened knowledge or sense of awareness regarding a number of pertinent and important issues and information regarding health care. It has been quite ironical that genesis of patients knowing or getting to understand the usage of their potential influence in health care sector. This has also been the case with overall changes in health care landscape along with the patients’ consumer power in the health care industry. These implications and others not identified herein have been made efforts towards ascertaining effectiveness of health care systems and sector be regarded as not of any essence as far as consumerism in the health care industry is concerned (Adeoye and Bozic 2007:98). Most of health care goals have not been able to be achieved and most of the providers of health care services have also failed to ascertain efficiency and proficiency in their initiatives of health care provision. The eventual reality has been lack of consumer satisfaction by health care providers. Involvement of Patients and the Public in Healthcare Consumerism in the National Health Services has had an aspect of community participation. This has been seen to employ power-sharing especially amongst communities implied into it and decision makers in the community. There have been different levels in place for the community as far as power has been concerned in matters related to health care. Arnstein (1969:218) presented a ladder of levels of participation from community with a scheme of framework that is useful in making considerations on how to engage the community publicly. From Arnstein’s ladder of community participation, there are eight rungs of which the bottom has “Manipulation and Therapy. These two rungs describe levels of non-participation that have been contrived by some to substitute for genuine participation. Their real objective is not to enable people to participate in planning or conducting programs, but to enable power holders to "educate" or "cure" the participants,” (Arnstein 1969:219). There are also rungs of Informing and Consultation levels based on tokenism. Through power holders, these are a total participation extent and community members may both be heard and hear. However, these conditions do fail to offer power for insurance as far as their views are concerned. Arnstein (1969:218) also describes other rungs: “Placation is simply a higher level tokenism because the ground rules allow have-nots to advice, but retain for the power holders the continued right to decide”. Going up the ladder are citizen power levels with increased decision making degrees. Community members can get into Partnership which allows them to engage in negotiations and take part in trade-offs along with typical power holders. At the topmost level of the ladder there is Delegated Power as well as Citizen Control. From these, citizens who do not have are able to acquire much seats of decision making or the can as well gain entire managerial power. Tensions between the Rhetoric/Goals of Patient as Consumer and Reality There are tensions regarding rhetoric/goals of patient as consumer and reality. One major one is on basis of conceptualization in which communities or citizens are a presentation of heterogeneity. This is further based on interests, demographics and concerns which generate problems in establishing or determining right persons who are at the same time legitimate as the community’s representative. This further leads to lack of mutual association with medical practitioners. Arnstein (1969:217) identifies another area of concern as “Evaluation: The way in which community participation is expressed varies considerably in different contexts, making comparisons complex. As community participation is one of many concurrent strategies addressing particular health problems, measuring the effect of community participation on health outcomes is difficult”. This has been attributed to difficulties in forecasting so as to help in coming up with more integrated and advanced approaches as far as incorporating communities is concerned in participation initiatives (Thorogood 1992:34). Moreover, it alters efforts to make healthy strategies and formulate appropriate systems for addressing health issues in a given community. Another area of tension is representation. There has been poor and inadequate representation from a number of varied sections from the population. Most of the segments represented have always shown conflicting opinions and views thereby derailing any intended processes for addressing health issues and problems (Wolfe 1971:532). This is due to the fact that through divided views, a uniting factor is never embraced by all parties therein. Following this, tension is multiplied therefore not contributing to any considerable development as far as addressing health care problems is concerned. However, through guidelines on good practices for participation in health initiatives by the community, a number of strategies have been handy in ascertaining there are realized positive outcomes. These have generated a health care that is more centered on patients as health care consumers. Challenges to Placing Patients at the Centre The challenges accruing from the approach is that even though there are essential decisions regarding it, “too often onlookers dismiss the importance of beliefs or experiences that often lie at the centre of motivations as individuals” (Ryan et al 2009:76). This is a challenge in terms of ensuring that there is proper address on health care problems. Another considerable challenge is the fact that placing of power upon some characters especially on personal views may end up with shattered power following intrusion by strangers. Gaining an ascertained empowerment for health care consumers is another potential challenge. This follows the fact that main stakeholder who in this case are patient who at the same time form the main consumers may not be able to make formidable choices (Adeoye and Bozic 2007:103). Rather, they are deemed to concentrate mostly on failures of health care systems. This has got a great potential of bringing down transparency as regards health care services offered. Conclusion Health care consumerism has succeeded in placing the patient at the centre of healthcare following its potentials to keep healthy in especially when there are initiatives to sustain it by strengthening consumer power. As depicted from the paper, this can be achieved and be ascertained through provision of better user information and appropriate systems for handling health care user complaints and issues in general. Besides, there should be considerations made regarding representation of health care consumers at different levels attached to health care services. Furthermore, there are mechanisms for health care consumerism which is handy in as much as health care is to be enhanced. 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