Are Patients Consumers?

The folks at FrameWorks called out a recent article by Paul Krugman in which the economist argued – or railed, muscularly, as is his narrative style – against the notion of patients as health care consumers.

“Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough…The idea that all this can be reduced to money — that doctors are just “providers” selling services to health care “consumers” — is, well, sickening. And the prevalence of this kind of language is a sign that something has gone very wrong not just with this discussion, but with our society’s values.”

Citing research conducted between 2002-2004, the FrameWorkers say that the Consumer Model is the dominant frame influencing how Americans think about health care. To strategically reframe the topic, their recommendation is to introduce the value of “Responsible Management” — that is, appeal to the “citizen problem-solver” rather than the “citizen consumer” — into the discourse.

But in order to fundamentally change how Americans view health care — in order to move away from the Consumer Model to…well, what? A Social Service Model? We wouldn’t call it that, of course. Maybe a Membership Model?  — we need to acknowledge that the consumerist transactional frame fits snugly into the larger consumerist cultural model that governs so much of American thought. And, importantly, any alternative frame needs to account for and emphasize new sources of power from which people-cum-patients can draw and flex when they become involved in the health care system.

Within the Consumer Model, when you’re wearing the hat of the patient and the health system let’s you down — say, the nurse gives you attitude or the physician interrupts you or doesn’t even elicit your narrative experience with a given condition — you can exercise dollar voting. You can switch providers, or at least make the threat. You can take your “business” elsewhere.

The consumer model equips people-cum-patients with an internal locus of control, and any attempt to reframe how people conceptually understand healthcare must address similar power issues and the underlying emotional concerns.

Otherwise, this is what we face:

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