[Note: This post is part of an ongoing series on Big-Picture Health Care. The introduction to the series is here.]
Oddly enough, as I begin this series on the broader view of health care, I am fighting off a bad cold or a light case of H1N1. It’s a good reminder to start this analysis with the most important piece of the puzzle: people.
Call them stakeholders, participants, actors, or whatever, but any discussion of the power dynamics of change in health care necessarily begins with a rundown of who cares and why. Today’s post and tomorrow’s will take a look at who the players are and what’s in it for them, beginning at with the two groups where health care takes place:
Patients. Overcited and underdefined, this is supposedly the group for whom health care reform is being pursued. Don’t believe that for a second.
In the current framing (assuming Joe Wilson doesn’t know something I don’t), all patients are citizens, but all citizens are not necessarily patients. “Patients” generally means recipients of health care, whether that care is preventive, routine, maintenance-oriented, chronic, or critical. In order to be a patient, a person needs to receive some service or product from a medical professional aimed at producing some outcome. Let’s hold the discussion of what a “medical professional” is for a moment.
Once people are patients, what they want is pretty straightforward–it’s usually living longer or with a higher quality of life, often both, and at a cost that leaves money for luxuries like food and housing. Patients will often make demands about methods or frequency of care, but this can be driven by an ignorance or an inability to influence the outcomes of longer and higher quality life. Patients tend not to have a lot of power on their own as they are usually not as knowledgeable about health care as medical professionals and not as powerful as the companies and governments that choose whether to pay for their health care. Only slightly more powerful are…
Medical Professionals. This is a group whose definition is up for debate. I tend to think of them as comprising doctors, nurses, pharmacists, physical therapists, researchers, EMTs, hospice care workers, and perhaps homeopaths. Others might want to include acupuncturists, hypnotherapists, shamans, and other representatives of what tends to be lumped together under the auspices of “alternative medicine”.
Medical professionals employ knowledge and training in the attempt to promote longer, higher-quality life. Once thought to be very powerful, many medical professionals now protest that their choices and livelihoods are constrained by insurance companies on one hand and lawyers on the other. Some of these concerns are clearly legitimate, while others are a little murkier. What is not in dispute is that most medical care to patients is provided by this group–and everyone else involved operates at some remove from giving and receiving care.
A doctor friend once told me that he has only three options in treating his patients: he can cut them, he can give them medicine, or he can counsel them. Tomorrow we’ll take a look at who influences or controls those decisions–insurance companies and government–and we’ll finish our look at the players by observing the many players who influence the insurance companies and the government, especially lawyers, regulatory agencies, and taxpayers. Once we have this picture reasonably complete, we will be able to look at the levers and dynamics of producing change in the health care system.