By Bill Peckham
Clayton M. Christensen and Jason Hwang have an article in the Atlantic suggesting one way to improve health outcomes would be by empowering patients. Power to the Patients suggests three ways to do this: provide patients access to their health records; physician participation in online communities e.g. discussion boards; and rating systems. Christensen and Hwang use the experience of people dealing with diabetes to illustrate the advantages of empowerment:
Insulin-dependent diabetics, for example, quickly learn how to manage their blood glucose levels at home by matching their insulin dosage to changes in their diet and physical activity. Many diabetics have also joined online communities to share information and advice, sometimes viewing each other as more trusted advisors than their own doctors. Diabetics who take their health in hand in this way find that the cost of care decreases dramatically, while the quality increases: it’s far more effective than relying on experts whom they may see only every few months.
People on dialysis experience the same dynamic (it's often after their own or a loved one's online research that people seek out more frequent home hemodialysis).
It's really in managing chronic illness that patient empowerment becomes important. Christensen and Hwang don't make the point directly but it's the growth of chronic illnesses that makes empowerment an important, yet little discussed, strategy to improve healthcare. The person with the chronic illness has far more control over their clinical outcomes then their physician. Christensen and Hwang focus on the power of information per se to improve clinical outcomes, the assumption is that if you know what is best you'll make good choices.
Unfortunately human nature being what it is that doesn't always work, if it did no one would smoke cigarettes. Information alone does not reliably change an adult's behavior. Cash. Cash changes an adult's behavior. Achieved your clinical goals? You get $200 off your quarterly Medicare premiums. For those on dialysis it may be managing phosphorus or keeping fluid gains down between treatments. Health care reform should direct financial incentives towards those with the most control over clinical outcomes, the patients.
Pay less for performance. If you perform, you pay less. We'll know patients are empowered when they are the target of financial incentives.