If you have ever been a patient in a hospital, or visited a loved one there, you probably know what a dismal experience it can be. Aside from the quality of medical care you may have received, the hospital stay itself is often stressful, depressing, and frustrating. There is the poorly appointed room that feels nothing like a bedroom, the inconsistent visiting times from your physician, the interruptions every time you fall asleep, and the feeling of being out of the loop from an information point of view. And, at the end of it all, you get a bill that requires professional assistance to understand what you are being charged, and what you actually owe. How would you respond if you received a similar invoice after a stay at a fine hotel?
Why is the patient experience consistently poorer in healthcare than in almost every other industry?
In a recent article by Stephen C. Schimpff, MD (the author of The Future of Healthcare Delivery) titled “Patients Are Not the Customer,” Dr. Schimpff highlights five reasons why our healthcare system is broken. First, we have a medical system focused on disease and not a health system focused on wellness. Secondly, this system was designed over decades to treat acute illnesses, not the chronic diseases that make up the bulk of US healthcare spending today. Third, far too many patients are uninsured or underinsured and, with a primary care physician shortage, many will continue to depend on expensive emergency room services for basic primary care even after Medicaid is expanded.
Schimpff’s last two reasons touch on the patient experience:
Our system of care is not patient-focused. He is right. In what other industry would you wait long periods to make your purchase, spend hours waiting in drab rooms reading outdated magazines, and all for a far too brief encounter lasting minutes? When you require a specialist appointment, does your doctor call ahead and fill the specialist in on all the details so that she is well-informed when you arrive? Not likely. But the truth is, we are paying little, if any, beyond a small co-pay when we visit a physician. It is not what we come to expect in a typical customer relationship, where payment is for services rendered.
And then there are the insurers. We are not their customers either. Our employers or the government are the customer. You feel that too. How easy is it to get someone on the phone to help with a claim or to clarify coverage for a procedure or a prescribed medicine? Schimpff concludes that without structural changes to the delivery system, we will remain bystanders in a complex, dysfunctional, three-way relationship.
Change is coming, but it will be slow. In the future, we will be paying more out of pocket for care and that will add leverage to our position. In addition, new care models are on the horizon which will offer patients provider choice but will penalize providers when their assigned patients seek care elsewhere. In these models, we can vote with our feet and that will create an incentive for providers to build loyalty to their practices and hospitals.
In my next post, I will discuss why hospitals and physician practices should care.