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Gary Puckrein

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The Democratization of Health Care: Empowering the Consumer

Posted: 04/19/2012 4:50 pm

The market forces that are capable of eliminating health care and health status disparities are gathering. On April 23 and 24, about 700 of my closest friends will join me in Washington, D.C., to discuss minority health. This will be National Minority Quality Forum's ninth Annual Summit dedicated to understanding health disparities -- the poor quality of health of minority populations compared with the white majority, and the lower quality of care that is provided to them. But the context is changing.

Minorities constitute an emerging majority: 40 percent of the U.S. population by 2020, 50 percent by 2050. White, non-Hispanics are currently 66 percent of the population, yet their care absorbs 80 percent of health care spending, according to data from the Agency for Healthcare Research and Quality's Medical Expenditure Panel Survey. Our health care system is not built to provide optimal care to a diverse population. The problem begins with the under-recruitment of minorities in clinical trials and extends to minority-serving hospitals (yes, most minorities are served by hospitals that are distinct from those that attend to whites), many of which are struggling to survive.

The casual observer at the Summit may get stuck on the fact that disparities persist for every imaginable health status parameter. The discerning participant will be excited to learn that there may be a way forward: a Consumer-Oriented Healthcare System. The idea is to use the purchasing power of all consumers to support the systematic, expeditious discovery and distribution of medical care to improve life for diverse populations in a timely and cost-efficient manner. Obamacare has set the stage for consumer power to eliminate all forms of disparity in our health services research, delivery and financing system.

Astute private insurers already know that the Affordable Care Act presents them with a new and enhanced customer base. Through state-run health exchanges created by the law, millions of minorities who were uninsured will begin selecting private insurers. The development of these exchanges offers a unique opportunity for minorities as the market learns how to create products and services that cater to their experiences. There will be robust competition for these newly-empowered consumers as companies fight for market share. Insurers will quickly learn that the cost-containment strategies (e.g., drug formularies, denial of coverage, coinsurance) that worked well in an employer-based health care market will go over like a lead balloon in a market driven by independent consumers who are looking for value. It will be a spectacular success if insurers begin vying for these new customers by touting their abilities to collaborate with providers (physicians and manufacturers of drugs and devices) to improve health outcomes, using real numbers to drive home their points.

Our hope is that the new health care market that includes minority populations will flourish, powered by consumers whose new access to insurance will reward pioneering companies for their innovations and health care providers for their skilled and effective services. Stubborn disparities in quality and outcomes should disappear as businesses begin investing in minority health, recruiting minorities into clinical trials, and educating minorities about new products and services that can extend and improve their lives.

Government can play a critical role in the development of this emerging market by enforcing transparency, arresting fraud and abuse, and guaranteeing the safety and efficacy of medical care. Government can encourage investments that address unmet medical needs, and it can support efforts to find cost-efficient solutions for therapies that currently fail to satisfy consumer demands. Government can also review and remove legislation, regulations, and policies that frustrate consumer demand and that discourage investments in the development of innovative products and services. In a Consumer-Oriented Healthcare System, government operates within certain boundaries. It does not institute price controls; shift costs to beneficiaries in government-sponsored programs; reduce the availability of new therapies while promoting older, less-expensive treatments; over-regulate the practice of medicine; or distort communications between consumers and providers.

To eliminate disparities, we need a Consumer-Oriented Healthcare System in which the market responds not to government edicts, but to the needs and preferences of all consumers, including minorities. Government has a proper role to play in such an economy, but it must not allow anxieties about the future to cause it to behave in ways that undermine our free market.

 
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