Where Are We With Consumer-Centric Healthcare Delivery

Dr. Vidur Mahajan, Associate Director, Mahajan Imaging

I am going to make a confession about Mahajan Imaging, the chain of radiology centres that I run – we track several metrics as part of our quality program, but one metric that always stands out negatively, is waiting time. The waiting time issue, if I can call it that, is one that is generally restricted to MRI scanning and ultrasound scanning. There are two perspectives of viewing this parameter, the consumer’s and the patient’s. From a “consumer” standpoint, making someone wait is probably the worst thing one can do to a consumer. It might indicate that a service provider does not value its customer’s time, and hence does not value the customer themselves. Conversely, if we view this parameter from a “patient” and “clinical” standpoint, we realise that the reason most patients face the waiting time issue is because some other patient needed some more time to, in our particular case, build a better and more accurate diagnosis. What this should indicate to a patient is that the service provider would similarly give extra “time” to him/her as well, hence arriving at a proper, more accurate diagnosis. In fact, we have had patients say “time management needs to improve” and “please adhere to appointment timings”, but in the same breath say “report is very detailed” and “doctor explained the report very well”. Healthcare today lives somewhere between these two extremes, and I believe that is where it should stay.

To talk about “consumer-centric” healthcare delivery, we would first need to define what it means. Consumerism is typically defined as a movement towards protection of the rights of the consumer, eventually leading to an increase in consumption of the service in question by increasing demand for the same. Consumer-centric healthcare, in turn, refers to a trend of empowering patients to make their own healthcare decisions, akin to how consumers make a choice about buying – evaluate quality and cost, and take a decision.

The problem with consumer-centric healthcare is three-fold. First, indicators of quality do not necessarily indicate true quality. For example, a consumer (or shopper/buyer) might consider long waiting time to be an indicator of poor quality of service – “how can they cure me, when they can’t even stick to an appointment?” – where waiting time has no real connection with the outcome, whether it is a diagnosis, a treatment procedure, or just a follow-up consultation with a doctor. Second, while the traditional information gap that existed between the patient and the doctor is being bridged by “Dr. Google”, unfortunately the bridge leads to more distrust and hence problems that were before. Just today I was given the example of a patient who was having pain in the hips and subsequently advised an X-Ray by his physician. The patient searched the internet and found that an X-Ray might not be required in his case and consulted his physician, who explained to the patient that he is taking a drug that can lead to osteoporosis and even fractures, hence the X-Ray. Eventually, the patient was diagnosed to have an even worse condition (bilateral AVN of the femur) for which he needed two hip replacements. It seems appropriate to summarize this second issue with the age old dictum – a little knowledge is a dangerous thing. Finally, there are issues related to direct marketing of healthcare services to patients. Not only is this dangerous since it leads to price-undercutting between healthcare firms, but it also leads to confusion in the patients’ mind. It gives the patient the impression that their trusted neighbourhood hospital is now “commercial” where in their heart of hearts, the hospital wants to stay exactly the same.

That said, there is no denying that adding a consumer angle to the healthcare industry helps improve quality in the industry across the board. Again, there are three ways in which “consumerisation” of healthcare is helpful. First, and maybe most importantly, it drives transparency – all said and done, with price and information no longer being “hidden” and patients having access to both at the click of a button, healthcare providers are forced to make decisions that are optimized for each individual patient. While this may sound contrary to what was written earlier in the article, it is important to realise that cost-optimisation is important for patients in India since not only do they pay out of pocket, but they also often compromise on other aspects of their lives – savings of a few thousand rupees can mean that a child’s school fee can be paid by the patient – such is the world we live in. Second, related to the first, consumerisation of healthcare will definitely lead to improvement in quality of services provided. A study done by Wes Yin et Al at UCLA, California studied the impact of introduction of consumer-centric, quality conscious pharmacies in south India and its concomitant impact on the quality of the other pharmacies in the area. The results were astounding – not only did pharmacies try to improve their look and feel, but there was also real improvement in the quality of drugs sold! Such is the power of a demanding consumer! Thirdly, consumerisation leads to awareness about healthcare, and hopefully will lead to a shift in patients’ currently prevailing “curative health” mindset, to a “preventive health” mindset. Once people know that a certain disease can be prevented or detected early, they will hopefully start acting on the same.

So is consumer-centric healthcare delivery a boon or a bane – well the answer clearly lies somewhere in between. I truly believe that the way forward for healthcare providers lies in having frank conversations with patients. While I realise that this is easier said than done when one is dealing with a country with one of the worst doctor-patient ratios on the planet – but still, what doctors need to gain is patients’ trust, and that is something that does not come easy. So, if there is one thing I would request you, the healthcare provider, take away from this article, is to lay emphasis on communication with the patient. If the patient understands the thought-process behind a decision that a doctor has taken, there is a chance that Dr. Human trumps Dr. Google and leads to not only lesser confusion and misinformation, but also to improved clinical outcomes and hence, better healthcare overall.

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