How Consumers and Businesses are Reshaping Public Health

Through a collection of case studies, John A. Quelch and co-authors explore the intersection of health care and business in the new book, Consumers, Corporations, and Public Health. Read an excerpt.
by John A. Quelch

Consumers Corporations and Public Health

Editor's note. In the United States, a primary provider of health care is through employers. "Every corporation is a player in public health," writes John A. Quelch in a new book of case studies, Consumers, Corporations, and Public Health. Written by Quelch and colleagues, the studies explore interactions between private business and public health, and demonstrate how consumers can create better and less expensive care for themselves.

Book Excerpt: Consumer Power in Shaping Public Health

Healthcare and education are two issues in which citizens around the world, rich and poor, are passionately interested. It has long been appreciated that the way that a society treats its youngest and oldest members says much about its moral maturity. Economic development specialists also attest to the importance of health care in determining productivity. The connection between child health and nutrition and readiness to learn in schools is also well established. Forthcoming revisions to the Millennium Development Goals are expected to again highlight the importance of disease prevention and health care to the global community.

Nevertheless, the pressures of commercial competition all too often still result in decisions that take scant account of public health and whether the health of individual citizens is being advanced. When worker safety is jeopardized by unenforced building codes or exposure to harmful industrial chemicals, that becomes a public health issue. Bangladesh garment factory owners engaged in cutthroat price competition to secure orders from Western manufacturer and retailer brands. These brands conveniently sourced their requirements at arm’s length through third-party intermediaries to avoid any responsibility for workplace conditions. Then, the Rana Plaza disaster that killed over 1,000 factory workers in Bangladesh in 2013 highlighted to Western consumers the challenging conditions faced by the workers who made their clothes. Consumer pressure on Western retailers worked its way back up the supply chain to force improvements in workplace conditions. In this case, Western consumers were taking responsibility not for their own health but for the health and safety of workers in a foreign land thousands of miles away.

Consumer power has not been that evident as a criterion in shaping the financial decisions of major multinationals. Merger and acquisition activity in the healthcare sector invariably occurs with scant regard for the impact on public health or the end consumer. Pfizer’s attempted takeover of the British company, AstraZeneca, in 2014 was criticized widely for being motivated by financial engineering; the combined company would be headquartered in England in order to achieve a lower corporate tax rate. The British government favored the merger as it would boost the high-priority life sciences sector, but little attention was paid to whether the integration of the two company research groups would delay the development and commercialization of important new drugs to the detriment of consumers. Interestingly, though, at public hearings, the AstraZeneca chief executive championed the interests of patients in opposing the proposed merger.

Consumers worldwide are increasingly taking charge of their health. As populations age, there are more consumers than ever before suffering from chronic conditions. Most no longer see disease and the timing of their death as inevitable. Supported by the Internet, many actively seek out information to increase their odds of staying alive. Aided by family and friends, they research their conditions and possible treatments, often sharing their experiences with others in online communities. They are more inclined to question authority, and to raise issues with their doctors, care providers, and pharmacists. Some providers view such patients as wasting their time, but most recognize that patients know themselves better than anyone and therefore value their insights. Of course, not everyone is interested in or capable of engaging in the management of his or her own health. Some are fatalistic; others avoid doctors and hospitals at all costs; still others are simply too sick to help themselves. Any public health system must respect the reality of these consumer differences and not withhold care from people simply because they do not engage and do not speak up. As Atul Gwande has stated elegantly, “Patients are pleased to have their autonomy respected but exercise of autonomy includes the right to relinquish it.”

Consumer empowerment is perhaps more evident in the United States than other developed economies served by single-payer national health systems. In the United States, most citizens see each month on their paystubs a significant dollar sum deducted for health insurance. Every year, they have to review alternative health insurance plans, make risk-return tradeoffs, and choose the ones they prefer for themselves and their families. In Japan and Western Europe, most citizens receive their health care “for free” through a national health system, funded by taxpayers. The result can sometimes be a less empowered, more quiescent patient population. Interestingly, many developing countries operate more like the United States. Lacking the resources to fund meaningful national health programs, individual consumers are left to fend for themselves, seeking private treatment that they and their families can afford. In poor countries, consumers are best advised to keep their own medical records since nothing approaching an electronic record-keeping system is available.

As a result, enormous innovation in the delivery of good quality but low cost healthcare services is taking place from Asia to Africa. In India, the Avarind Eye Hospital provides routine eye surgeries to the highest quality standards at perhaps a tenth of the developed country price. A mass production approach to other routine surgeries, such as hernia operations, provides similar savings. In the area of prevention, the spread of ever-cheaper mobile smart phones enables citizens in remote rural areas to receive online medical consultations, treatment suggestions, and prescriptions. Readings on diagnostic machines in clinics can be taken by nurses or community workers, transmitted electronically and interpreted by specialist doctors working in city hospitals. When the time from data collection to treatment can be cut thanks to mobile health care, lives can be saved.

Mobile health is gaining traction in developed economies as well. The Fitbit and other wristband products that enable consumers to self-monitor exercise levels, sleep patterns, and blood pressure have sold briskly. Despite Google Health’s failed effort to facilitate patients’ collecting their medical records electronically in one place, there were around 40,000 health apps available by 2015 for 1.6 billion mobile smart phones, and the advent of Apple’s Healthkit, also deployed in the new Apple Watch, promised to stimulate broader use and more innovation. Many of these products, sometimes faddish in nature, appealed to a younger generation of healthcare enthusiasts or to the worried well—those who are basically fit but who make an effort to look after themselves. The importance of consumers working to preserve their health though sensible, preventative measures cannot be underestimated; these consumers are reducing or at least postponing their eventual burden on the healthcare system.

For those already sick, mobile health adds equally important benefits. From remote monitoring to in-body sensors, mobile health innovations enable patients to spend fewer expensive and less than pleasant days in hospitals and more days getting better or managing their illness in the comfort of their own homes. The temptation to undertake continuous rather than snapshot monitoring can, in some cases, be unproductive and costly, and risks turning patients into hypochondriacs. Mobile health innovations should be adopted widely only after controlled consumer experiments have demonstrated their value added in terms of improved patient outcomes.

Related Reading:

Can Consumers be Trusted with Their Own Health Care?
How Should We Pay for Health Care?
Is Health Care Making You Better—or Dead?

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