We hear about it on the news, we read about it in the newspaper, and we talk about it around the water cooler: healthcare consumerism. Built on the premise that higher engagement leads to better outcomes, healthcare consumerism is playing a central role in healthcare reform. After all, the public and private exchanges are consumer marketplaces where health insurance “shoppers” compare plan benefits and prices to determine what health plan to purchase.
The idea is that when people are given more choice (with respect to health plan benefits and price points) and responsibility (decision-making and cost-sharing), they are more active participants in the management of their healthcare. In assuming this larger role, people behave as consumers. The end result? Collectively, we improve the effectiveness of our healthcare system.
Yet, healthcare consumerism is also a heavily debated topic. People on both sides of the discussion are waiting until after the next round of ACA mandates take effect in 2014 to see how—and if—the public embraces the concept of consumerism (in regards to its healthcare). Proponents believe the paradigm shift will ultimately make a positive impact on all stakeholders in the system; critics caution that healthcare isn’t an appropriate arena for a consumer mindset.
There’s no argument, however, that in order for healthcare consumerism to gain momentum, people need to keep learning—about how health insurance works, what questions to ask their physicians, and how their lifestyle choices impact their healthcare costs. If consumerism leads to increased engagement, increased accountability, and better outcomes, then we can expect to benefit from a population of consumers who are more informed, collaborative, and therefore healthier.
A Healthcare Consumer is More Informed
Since managing ones’ healthcare is becoming so multifaceted, it takes knowledge in these key areas to successfully navigate the system:
- Insurance. From selecting the right health plan in an exchange to reading the insurance company’s explanation of benefits, consumers will understand their coverage and know how to effectively use their plans.
- Medical. Part of being involved in the process of healthcare is engaging with caregivers, so consumers will ask questions or conduct their own research about medical diagnoses, treatment options, care plans, disease management, and more—especially as these topics relate to healthcare costs.
- Financial. Today’s consumer-driven health plans give people more control over their healthcare dollars, so when it comes to cost-sharing and budgeting for health-related expenses, consumers will know what they are being charged, what they are paying for, and why—so they can get the most value out of their money.
A Healthcare Consumer is Healthier
A person who’s engaged in their healthcare knows how their behaviors impact their costs. With an incentive to take care of themselves, they make better choices: taking prescriptions as directed, exercising, managing chronic conditions, and eating healthy. What’s more, all health plans are required to provide first-dollar preventive care services, so people will get the evaluations and screenings they need before health problems arise or worsen.
A Healthcare Consumer is More Collaborative
Every party in the business of healthcare will need to work together—with the consumer at the hub—to ensure healthcare needs are met effectively and affordably. People will depend on their employers to provide information about their health benefit options as well as decision and healthy lifestyle support tools to help them maximize their participation in their benefits package. Healthcare professionals will work with patients to understand the details of treatment options, from alternatives to costs, resulting in better healthcare choices and outcomes. Consumers will communicate with their insurance company to ensure they’re utilizing their benefits correctly and making the most of their coverage.
For more information on healthcare consumerism as it related to healthcare reform, check out our Resources page.