Out of patients: the political economy of health care consumer ‘empowerment’ in the United State
Faculty of Information and Media Studies, The University of Western Ontario - Canada
Out of patients: the political economy of health care consumer ‘empowerment’ in the United States
The American health care system has changed dramatically since the 1980s, with increased privatization, restructuring towards a managed care (MC) model, increasing corporate profits and a focus on cost containment. During this time period, ‘consumer empowerment’, has become a popular concept in American health care. ‘Consumer empowerment’ is widely positioned as a good thing for patients, as they become more informed and make choices regarding their care. However, critics suggest that ‘consumer empowerment’ has consequences. ‘Consumer empowerment’ may transfer responsibility for care onto individuals, forcing them to make choices they are not prepared to make, pay more for their care, spend more time treating themselves and their families, and take health risks. Critics also argue that ‘patient control’ does not have the clinical value that has been suggested. Concerns have also been ra ised about the quality of health care under MC. This presentation will examine the question of who benefits from ‘patient empowerment’ in the United States. Through an examination of the MC health system, and its network of private insurers, for-profit providers, government programs, and individual payors, I will explore the structure and flow of financial benefits within the American health care system. I will also discuss the commodification of consumer health information (CHI) that has accompanied the shift to MC, such as through the widespread adoption of ‘disease management’ programs for chronically ill individuals. Within this context, I will examine the interests behind the discourse of ‘empowered’/’informed’ consumers. Because of the structure of American health care, consumers may have no choice but to become involved in their care; yet this contradicts the notion of gaining control that is present in the idea of ‘empowerment’. Health information professionals would benefit from considering these implications of their work, and from exploring opportunities for practice that challenge and disrupt this context.