A. Sharing responsibility for a complex problem

The current lack of consumerism in healthcare is a complex problem for which every sector of the industry shares responsibility.

As many economists have noted, the fragmented healthcare system in the United States has stymied the usual market forces that might otherwise lead to greater efficacy and efficiency. Yet, enthusiasm for greater “consumerism” in healthcare has been dampened by generally slow progress. What practical components are necessary to move consumer empowerment from an ideal to a reality?

The answers are rooted in responsibility: who has it and how it is exercised. Regina E. Herzlinger, the Nancy R. McPherson Professor of Business Administration at Harvard Business School, forestalled the temptation to point fingers by drawing an analogy to Agatha Christie’s mystery, Murder on the Orient Express. Herzlinger said, “Somebody on the Orient Express gets killed, and the question is, who killed him? The answer is, everybody on the train killed him. And the answer about who killed healthcare is: the status quo.” Everyone owns a share of the responsibility.

Every nation, too, suffers a share of the fiscal consequences. “No matter what the country, no matter what the public policy,” Herzlinger said, the rate of healthcare expense growth relative to the growth of the GDP “is very, very high.” What will happen, according to Herzlinger, is that healthcare, like other industries, will have to conform to market forces and by doing so will become more “consumerized”: Patients must assume greater responsibility for their care and must have greater power to exercise that responsibility. She cautioned, however, that when it comes to policies and technologies intended to give consumers more control, “we’ve got a lot of hallucinations rather than visions.”

Her skepticism was echoed by the survey results. “Consumer incentives to encourage healthy behavior” ranked last among eleven possible innovations in terms of their ability to increase value, with 44.6 percent of respondents indicating that it would have only a minimal or slight impact on improving quality and 43.9 percent noting its minimal or slight potential for controlling cost.

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