I got excited this morning reading an excellent “Perspective” article in the NEJM on public reporting, consumerism and empowerment. The penultimate paragraph of the article reads:
As patients become more sophisticated purchasers of health care, they will push competition in health care delivery to look increasingly like that in consumer-goods industries. This competition could lead to product offerings that appeal to consumers with different needs. While some patients may seek greater odds of survival, others may seek a faster return to work or lower out-of-pocket costs. These options are at the core of “patient-centered” care.
This is the wantified self, as described through medical parlance. It’s an idea whose time has clearly come.
The article’s focus is on how information about hospital performance needs to be more communicative for people to be able to use it. I’d argue that, although this is needed, what we really need is to go upstream and first understand what it is that people are trying to do in their lives. It’s through this deeper “wantification” can we – people, communities, and their health care providers – work together to help people be healthy in ways that they define.
The final paragraph also touches on an area that we’ve been discussing in exploration:
To move health care in this direction, public reporting must shift from “one size somewhat fits all” to an approach that reports metrics reflecting the varied concerns and preferences of consumers. With better information, millions more patients can become smart shoppers and, in the process, help bend the health care cost curve.
I’d extend this further and say that health care, not just “public reporting”, needs to move from a “one size somewhat fits all” to a more personalised form.
The word “personalised” has been colonised by genetics enthusiasts but I’d widen its definition. On a genetic level, we know our genome defines much about us, but it’s also influenced by our microbiome and (the recently-described) exposome. Beyond our genes and its influencers, we know that behaviours are influenced by our wants, our networks and our environment. All six things combine into a complex being that needs increasingly personalised forms of care.
As I’ve argued before (at the end of my post on the Wantified Self) health care needs to evolve from a supply-defined service to a demand-defined one. The provision of better information is an important step in this journey, and I applaud the NEJM authors, Robert S Huckman and Mark A Kelley, for their helpful piece.