Public As Consumers And Policy Makers Chap11 Flashcards
Consumerism
A social movement promoting and representing user interests in health services.
Consumerism is a movement that has appeared in many high and middle income countries since the 1960s, to protect consumer interests in private business relations. It extended later to public services, including health care. The underlying view is that providers tend to disregard consumer interests and therefore consumers’ rights need to be protected. Provider power needs to be balanced by consumers who actively monitor and evaluate health services and who make informed choices.
In turn, giving people choice, for example between different providers, is thought to improve the quality of services and people’s satisfaction. Consumer power is also seen to improve the responsiveness to complaints and strengthen people’s rights. In this concept, health care is regarded as being just like any other service, a commodity that can be produced and consumed. But is that true?
Initiatives to strengthen consumer power
These involve:
• better information
• complaints-handling systems
• representation of consumers at various levels of health services
• mechanisms protecting patients’ rights.
The protection of patients’ rights has been approached in two main ways: charters setting out entitlements and expectations, and laws. The former is the approach adopted in the UK, where health care providers have developed explicit standards that patients can expect to receive.
Has consumerism changed the heath care encounter?
There is no doubt that consumerism has been influential in challenging health care professions and increasing users’ power.
Deborah Lupton, an Australian researcher, has pointed out that seeing patients as consumers underestimates the cultural and emotional features that influence the staff-patient relationship. The feeling of dependency is central to the illness experience and may work against taking up a consumerist position. Illness, pain and disability tend to encourage a need for trust in experts and faith in health care. From her studies in Australia, there is evidence that the role patients take depends on their personal circumstances. In the health care encounter, patients may both pursue the ideal type ‘active consumer’ or ‘passive patient’ position, simultaneously or variously, depending on the context (Lupton 1997).
Do people always want the power?
Average citizens are, however, largely reticent about their ability to perform this collective decision-maker role…in Canada two-thirds of individuals did not want to take responsibility for priority setting
Public opinion trends
As regards public involvement in funding decisions, they generally want to increase spending on health care despite governments’ desire to control spending; for decisions as to what services to provide, the public often feel ill equipped and reluctant to be involved; and the public find the task of rationing (at the level of individual patients) too technically challenging, though no such reluctance exists if the decisions are limited to sociodemographic factors such as age or sex
Benefits of including patients
The aims of involving patients have always been broader than just improving the quality of health care. Involving patients has been viewed by many as a democratic or ethical requirement: because patients pay for services they have a right to influence how they are managed. An alternative view is that involving patients is not intended to devolve power to patients but to legitimise the decisions of policy makers and administrators. It is argued that through consulting with users of health services, support for decisions that would otherwise be unpopular can be obtained. Such aims imply that establishing mechanisms for involving patients should be seen as an end in itself rather than as a means of improving the quality of services.
Lomas arguments for Public involvement in health care
- Advocates of increased public involvement argue that public services are paid for by the people and therefore should be shaped more extensively by them, preferably by a fully representative sample. One assumption made is that greater public involvement will lead to more democratic decision making and, in turn, better accountability, but neither is necessarily the case.
- A second argument for increasing public involvement is that it will make services more responsive to the individuals and communities who use them and that more responsive services will lead to improved health. Underpinning these assumptions is the belief that professional definitions of benefit in health care can be at best only partial; only the users or local communities themselves know what they need, and it is ultimately their assessment of benefit that matters.
Community participation
A process by which individuals or groups assume responsibility for health matters of their community.
