Inside many of us lurks the unquenchable urge to shop, the hunger for a better deal. January white sales, cents-off coupons, buy-one-get-one-free, discount cards, cash-back deals: businesses know that consumers will walk a mile to pinch a penny.
Increasingly, that irresistible force is being unleashed on healthcare decisions. Web browsers visit sites like WebMD, Dr. Koop and the Digital Hospital and show up at their doctor's office with printouts of the conditions they think they have and the remedies they think they need. The visionary Overlake Medical Center in Washington State publishes a Healthcare Consumerism Checklist (at left) with information about patient rights, health records policies and on-line quacks. Direct-to-consumer advertising pitches Cialis and Celebrex and Viagra with million-dollar prime time TV commercials. And the U.S. Department of Health and Human Services even runs a HospitalCare analysis web site that compares key acute care indicies just like Yahoo! Shopping compares refrigerators.
The irresistible shopping monster could become a disruptive force on healthcare costs in the U.S. In a 2002 ruling, the Internal Revenue Service opened the way for Consumer-Directed Health Plans (CDHDs), one of the hottest new products in the world of employee benefits. In combination with a conventional health plan with a high deductible, consumers (and, often employers) contribute to tax-free health reimbursement accounts (HRA). The HRAs are used for normal medical expenses, but the money not spent on healthcare this year can be rolled over into following years, creating a growing asset protected from the tax man.
Traditional HMOs control costs by chiseling down invoices and denying payments to doctors through complex bureaucracies that nobody understands. Healthcare consumerism combines the need to stay healthy with the urge to save money and the desire to be in control. It may not be for everybody, but shopping has some real therapeutic possibilities.