Consumerism in Health Care Services

Abstract

H EALTH CARE in the United States is at a critical juncture in its growth. A corporate system is being built on an understanding of health rights and needs, and this system gives the medical care industry an inordinate amount of control over peoples' lives. Early in their development, many social institutions in America were available to the public as a privilege. Later, their services were offered as a right and finally as a requirement. An example is the educational system. Initially a formal education was a privilege for which some people were able to pay. Then education became a right-all children could attend school through a certain grade. Now, in most places, children are required to attend school until they are sixteen years old. Health care in the United States began as a privilege based largely on demand, a demand which arises when the individual is troubled or in pain, that is, when the person is aware that he is not feeling well and consciously seeks help. For example, a woman goes to her physician with complaints which he diagnoses as a urinary tract infection. Her complaint is, in an economic sense, a demand for care. The physician responds to the demand by treating the patient who, in turn, pays him for this service. This kind of care is a privilege secured by payment of a fee. Care is unavailable if the person cannot pay the fee. Now health care has been declared a right. The scope of health care has been extended byond demands to include needs. In addition, more and more health care is being paid for by third parties rather than the individual. On the surface, this development seems commendable. However, some serious problems are arising which rest on the definitions of rights and needs. While the new system of payments seems to be geared toward equity, a corporate system is developing which could be less, rather than more, responsive to what people feel are their needs. The term health right is being interpreted as meaning that people should have free and total access to medical care. Whereas, a person's right to free public education can be cut off at a certain age or stage of development, a lid cannot be put on health care. The assumption by health care as the leading national industry testifies to this. However, free and total access to medical care would mean bankruptcy for the country. Patients could demand to see one doctor after another. They could keep plaguing their doctor with a complaint until he did various studies, X-rays, even surgery. Problems can pyramid. Great thick charts already are not uncommon. Efforts to control costs through utilization review have had little success. Quality assurance of medical care evalua-