As we continue to attempt to restructure how health care is measured, reimbursed and organized, we must hold true to the idea that health care is simply not a service commodity.
“A commodity is any good or service (“products” or “activities”) produced by human labor and offered as a product for general sale on the market.” Our health care delivery model continues to evolve as we move away from the fee-for-service (FFS) model to our value-based health care model. Value-based health care is a health care delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes. The three main goals of value-based health care are as follows:
- Enhance patient experience
- Improve population health
- Reduce cost of health care
The value-based delivery model as a concept may yield better results than the previous FFS model, only time will tell. During this time of change we must not lose sight that “medical care is a special service and ought not to be considered a market commodity. It is qualitatively distinct from commodities, and the moral obligations which ought to govern medical economics differ from the moral obligations which govern the production and exchange of commodities.”
Health care viewed as a commodity has generated many health care metrics which are seen as drivers for success in health care delivery. Benchmarks that range from operations to finance to communications to emergency and care are used to indicate the effectiveness of our performance. All are necessary for the successful management of commodities in the marketplace. In evaluating these metrics, there does not seem to be a “seat at the table” for the patient-health care provider relationship. Although difficult to measure, there seems to be no clear set of provisions made to allow for more time to strengthen this relationship. Over the past decade, the general consensus by providers and patients is that there is less time available to interact.
The patient-health care provider relationship is fundamentally essential to the outcomes that we all seek. There are many outcomes that will continue to be measured, but the heart of our health care must center not just on the benchmark outcomes but the relationship between the health care provider and the patient. This relationship must continue to involve reciprocity as we develop strategies to increase patient involvement in their own health. Should health care providers now start to rate patients on engagement and compliance? It is possible that such a dialogue would generate new ideas regarding accountability. While we must remain flexible in this new age of health care delivery, the health care provider-patient relationship must continue to be nurtured as we navigate strategies to increase productivity, measure outcomes and maintain transparency.
Peter Spence is an emergency physician.
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