When It Comes To Healthcare, We Are Not The Customers

When you go to your doctor you are not the doctor’s customer. Ever thought about that? It is a very atypical professional-client relationship. And it affects the care you get.

Our care is generally good in theUnited Statesbut not as good as it could be nor as good as it should be. There are multiple problems to consider. First, ours is a medical care system not a health care system. We focus on disease once it has occurred but give relatively little attention to maintaining health and developing wellness. Clearly there is a need for greater attention to disease prevention and health promotion.  Second, our sytem developed over many decades to care for acute illness but today we are faced with more and more chronic diseases. Sure there are still patients with an ear infection or a broken leg. But more and more individuals are developing diabetes, heart failure (both of these now becoming epidemics), cancer, chronic lung disease and others. These are illnesses that generally last a lifetime (some cancers can be cured, of course), are complex to manage and inherently expensive to treat. They are best handled by a multi-disciplinary team coordinated by a primary care physician. But such is seldom the case today.

Third, of course, many do not have health insurance with some 47 million uninsured and many more underinsured. And as they obtain insurance or join the Medicaid ranks as the result of healthcare reform, there will be way too few primary care physicians to care for them. They will therefore continue to use the emergency room as their principle place for care.

Fourth, our system of care is not customer-focused. We wait long weeks and months for an appointment, spend long times in the waiting room and are frustrated that we get just 12-15 minutes with our doctor. Our doctor suggests that we go to a specialist but does not personally call the specialist to explain the issue nor to smooth the path for a speedy appointment.

And then there are the insurers. We are not their customer – our employer is their customer or our government is their customer but not us. And it shows – by our long waits on the phone, by the complex often hard to understand paperwork and by the frustration when the insurance we thought we had does not cover our latest tests, x-rays or specialist visit.

Indeed we are not the insurer’s customer nor are we the doctor’s customer. The physician is the customer – sort of – of the insurance company. We are mere bystanders. This is hardly the type of contractual relationship we have with our lawyer, architect or our accountant.

Why are you not the customer? Principally because our insurance has morphed into being prepaid medical care rather than insurance for an unexpected and expensive need the way fire or auto collision insurance is designed. So “insurance” pays for your routine visit to the primary care physician (PCP). The “insurer” dictates what the provider can charge. You have no say in this critical function that creates the professional-client relationship. Since you are not paying (at least not directly) then the physician gives you the time that makes sense given what he or she is being paid. Hence the 12 minute visit when you could have used much more to discuss sound prevention strategies or benefitted from your PCP actually coordinating the care of your chronic disease.

So a new vision for our system must make it a healthcare not just a medical care system. It must recognize the importance of intensive preventive care to maintain wellness. It must address the needs of those with chronic illnesses (who consume 70-85% of all healthcare claims paid) to both improve quality of care while dramatically reducing the costs of care. And it must be redesigned so that the patient is the customer that he or she should be. It’s doable but it means a rethinking of how our delivery system is structured. And there is much that the business CEO can do as I will begin to out line in my next post.


Stephen C Schimpff, MD is an internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center and consults for the US Army, medical startups and Fortune 500 companies. He is the author of The Future of Medicine – Megatrends in Healthcare and The Future of Health Care Delivery-Why It Must Change and How It Will Affect You  from which this post is adapted. Updates are available at https://medicalmegatrends.blogspot.com


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