OVERVIEW
Author: Kenny Liang, April 2010
Health care spending accounts for 10.8% of Canada’s gross domestic product (GDP) in 2008 to an estimated 11.9% in 2009 ranking Canada among the top 5 health spending nations per capita. At this rate, healthcare will account for 100% of government spending by 2026. There will be no revenues left for other areas of responsibility [Taylor 2006]. This is not just a Canadian problem – its global and even more serious in other countries. The cost of our health care is a threat to our economy. It’s an escalating burden on our families and businesses. Canada’s health system is deeply rooted in our culture. Canadians are proud to be able to offer health services to those who need it, regardless of status, ethnicity, or income. In Canada, many consider universal healthcare as a social right. However, the implications of this right make social transformation difficult.
As we look for ways to help sustain Canada’s health coverage some prevailing themes emerge. Multi-tiered system or the increase use of private hospitals and health services; payer shift from government to private insurance, employers, and eventually to the individual or family. In the current model, the individual is the one that consumes health services and often has the most influence and the least involvement in their health needs. Patient-centered health, individual accountability, caring for the caregiver, and preventative practices are continuous themes that have existed for decades. However, it is only recently that consumer-based health systems have been seriously taken into consideration. The role of consumer health is not only an important element for financial sustainment, but serves to change attitudes and social norms in a complex adaptive system. The health crisis is driven by rising costs to support the aging population, rising obesity, drugs and devices, and those living with multiple chronic diseases. Our societal environment and lifestyle choices are pivotal sources for our fragile health system. Health authorities have struggled by creating community level coordination of health services and allowing institutions to think about “patient-centered” care, however, there is still one critical piece missing in the puzzle – the consumer. Without individual involvement and accountability, our health system becomes highly reactive and serves to only mend deeper societal issues. To support the case for consumer health, the blending of public and private services, and the funding of physician incentives and consumer reimbursements is highly encouraged to boost consumer adoption. Rather than shifting costs to out-of-pocket (consumer direct payment), which has been more prevalent for services that have been deemed non-medically necessary by health ministries, the success of consumer health relies in both public sponsorship and the competitive efficiencies of market-driven firms. The same concept applies to a health informatics and its role in enabling consumer platforms and information based services. The future and savior of Canadian health lies in connecting individuals to communities and communities to health providers across traditional brick and mortar boundaries.
Definition and Role of Consumer Health
The definition of consumer health has two parts. First, consumer health encapsulates the idea of commercialization in healthcare. Commercialization describes the engagement of commercial providers in the provision of publicly funded services within the regulatory framework of private and public providers. Second, consumerism is a function to enhance processes and practices and that rely on active choices made by individual users or consumers.
In a recent consumer survey, Healthcare is considered a consumer market [Deloitte 2009]. Customers finds ways to navigate the system, adopts good information seeking behavior, consults expertise, and compares cost and quality before making a choice to consume a service or product. In Canada, this choice is not as evident and non-existence in some markets. The choice agenda in the public sector is moving towards commercialization and consumerism of public health care under the banner of “consumer choice”. In the current system, free choice is limited. Take for example, Ontario’s need for hip replacement surgeries that are offered through public programs and have been criticized for long wait-times. Many patients prefer to have a higher-performing prosthesis, but they are not allowed – not even to pay for the difference [Glover 2005]. In some provinces, insurance coverage is not permitted to cover these services. Our publicly funded healthcare tends to be “one size fits all.” The new healthcare framework with consumerism as collaborative approach would allow us to identify the different levels of need and develop more appropriate responses. The redrawing of public-private boundaries is a work in progress, however, the future of consumer market-oriented health policy and practice lies in “managed consumerism”, a blend of the patient-centric focus of consumer-driven health care and the provider-centric focus of managed competition [Robinson 2005]. In the context of this report, consumer healthcare is seeking an ideal blend where health providers and consumers take an active role in their health management, and in return, offer a new model for health sustainability.
Consumer healthcare can mean many things to many people. Consumer healthcare does not necessarily mean the privatization of existing services. Consumer health can be provisioned by a blend of public and private funding. The mission for consumer health is to empower individuals and communities to work collaboratively with health authorities with the goal to optimize an individual’s healthy lifestyle. The different market segments and opportunities include:
• Self-medication and over the counter drugs
• Preventative Medicine
• Natural foods and drugs
• Fitness, Wellness and Healthy living
• Chronic disease management
• Home care and caregiver support
• Remote consultation and patient monitoring
• Medical devices for remote patient monitoring
Patient-centered health is a form of consumer health in an institutional setting. When a patient is not in a clinical setting, consumer healthcare also encompasses the health roles served by individuals, caregivers, local health practitioners, and community support groups. In this case, the importance of consumer health is enormous; however, our health system is designed to support hospitals and primary care services. Consumer health is a complex initiative that has a new set of challenges foreign to policy makers and health authorities. The solution for consumer health starts with an understanding of the status quo and barriers to success.
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