Consumers can’t help health care. Customers can.

stethoasclepiusEconomically speaking, the American health care system is not built for patients, because patients aren’t the ones paying for it directly. Insurance companies are.

See, health care in the U.S. is mostly a B2B business. It is only B2C where insurance doesn’t cover expenses to the patient. And even then, insurance still often pays for it when patients can’t, don’t or both.

Over the decades, the U.S. health care industry has matured, so to speak, into an interlocked cabal of insurance companies, kieretsus of hardware, software and service providers, and captive regulators of both.

And because the system is mostly disconnected from the controlling effects of direct accountability to patients, costs and inefficiencies within the system have grown out of control. To say the least of it.

It is therefore a mistake to assume that patient involvement in the system is “consumerism” in either of its common meanings: 1) acquisition of goods and services in ever-increasing amounts, or 2) The protection or promotion of the interests of consumers.

We tend to make this mistake whenever we conflate customers and consumers in contexts where their roles are separate and distinct. We do this most commonly in businesses that offer B2C services paid for in a B2B way. The split between the two is real, but treated as if it is not. Thus we have companies going on about how much they care about their consumers, users or patients, when those persons have no direct economic influence over what they get from those companies.

Companies with internal splits between their customers and consumers tend to be blind to what it’s consumers actually want or need — or can bring to the market’s table on their own — because money comes from somewhere else.

I’ve seen this for decades in commercial broadcasting, and with publishers whose primary customers are advertisers rather than those who “consume” what is now called “content” (as if it were nothing more than container cargo), even if those consumers in some cases (such as with newspapers and magazines) are paying subscribers. The primary customers are still advertisers and their agents.

I’m seeing it today in the cabal of perpetrators and beneficiaries of the four dimensional shell game that online advertising has become. This is why its members, all B2B businesses, miss the clear signal “users,” “consumers” and “the audience” are sending with ad blocking and tracking protection.

The only way we can begin to fix the U.S. health care system is by making patients as powerful and engaging as they would be if they were full-fledged customers of the care they receive, rather than mere consumers of services. And this can only begin with better ways for each of us to take control of our own health care data (which is valuable to those services), and how it is used by services mostly paid for by others.

The best approach I have seen so far to this challenge is HIE of One, a project of two MDs, Adrian Gropper and Michael Chen. HIE stands for Health Information Exchange, which Adrian and Michael describe as “a patient-centered health record based on the FHIR and HEART interoperability standards.”

Here is the main reason I like its chances: it is based on open source code already in development. This means many developers can step in and help raise its barn, for all of us.

If you’re a developer, and you care about the health of your self, your friends and family, and the human species, I highly recommend stepping up and stepping in. I can’t think of any #VRM project with more leverage on the good of the world—as well as one country’s most essential yet fucked-up service economy.

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5 comments

  1. Mihai Pintilie’s avatar

    There are patients who pay, insurance companies that pay for patients but what about patients who can’t afford it? Start thinking about them first then the rest will follow.

  2. Doc Searls’s avatar

    Mihal, I am thinking about them. I am also using the term customer in a broader sense than I gather you suppose.

  3. Dragan’s avatar

    Great article Doc Searls!

    I really like the project HIE of one.

    Have a lovely day!

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