Often when healthcare is discussed the focus turns to technology or cost; however, there is an equally important, fundamental question that is being proposed, “Are patients customers?” The very notion that clinicians should consent to the demand that patients be treated as customers is against their training, intuitions and preferences. Yet, greater numbers of people from both inside as well as outside of healthcare are asking this question. Why is the patient as customer question emerging?
The patient as customer question is evolving from different directions. First, healthcare is transitioning into the retail environment (i.e. Walgreens’ “Take Care Clinic” and CVS’ “Minute Clinic”). Some relevant questions arising from this transition has led us to inquire even further: “Do we associate the retail patient as a customer? Perhaps more significantly, will the retail experience change the definition of a patient throughout the healthcare system?
Second, risk shifting has also been occurring within the healthcare arena, which has increased decision making, financial costs, and levels of involvement for providers and patients. For example, government payers such as Medicare have decided to hold providers and patients accountable for recognizing and controlling costs. In addition, health care organizations have begun to appreciate the business case for focusing on the patient experience. For these reasons and others, patients are now thrust into roles that many are simply unprepared to handle. Patients are now asking more questions about costs, increasingly demanding timely answers, and searching for reliable information on which to make decisions. At the same time, they are also feeling more empowered. The concept of introducing quality customer service to the healthcare industry is at its genesis. Unfortunately, the availability of data that may assist patients in making informed choices lags far behind the decisions that patients face.
Patients are now interacting with physicians and other health care providers in very different ways. As a result, there exists a very different health care environment. The examination room has quickly shifted from a hospital facility to an offsite office and now to the retail storefront. This trend also has seemingly provided permission for business perspectives to be introduced more explicitly into health care. Hence, some individuals are advocating for an overt change of title for those being cared for from “patient” to “customer” Other individuals strongly disagree with the previous position by advocating that healthcare is a specialized relationship. How can the patient and customer roles be reconciled? Our take is that there is more complexity to the situation than can be captured by two simple alternatives and that people take on many roles when they engage in a health care system.
Users, Buyers & Payers
One potentially enlightening framework may be found in thinking about the various roles that patients may play when they engage in health care in the following manner: User, Buyer and Payer. A patient actually performs all three roles when they alone: decide which physician to see, pay a large portion or even entirely out of pocket, and engage in the health care experience. These behaviors are seen, for instance, when a person shops for, buys, and obtains cosmetic surgery. Most of health care divides the three roles among various aspects of the service network.
The User. Ultimately, the user is the patient who has to manage his or her care despite, or as a result of, all the decisions made on his or her behalf.
The Buyer. A primary-care physician may refer a patient for specialized care, and alone decides the best provider for a particular patient. In this case, the physician is the buyer. However, patients may demand that they see specific providers (a primary provider that they’ve seen for years), forcing them to find ways to “work the system” to cover as much out-of-pocket costs as possible. Further, physicians are strongly considering things like communication skills and “bedside manner” when considering referrals to specialists, an indication of the channel power of the patient.
The Payer. Most likely, an insurance company (or the government) has a significant effect on which provider a patient might see, or even the system that is most cost-effective based on coverage. In this case, a third-party is the payer, and has some influence on health care decision choices. Increasingly, insurance companies (and even the government) are not paying for everything, which shifts risk to patients. Thus, the patient is thrust to some degree into the payer role, and has good reason to behave in ways that may appear to be an (overly) empowered consumer.
Patients as Customers
Because health care organizations want positive word-of-mouth and customer loyalty, it is true that “today’s patient is tomorrow’s customer,” . One guideline for identifying a person’s role in healthcare that has been presented is as follows: “The more horizontal they are, the more they’re patients. The more vertical they are, the more they’re customers” . The point is that a patient who progresses through a series of health care encounters for a specific condition finds himself or herself engaging in various roles at different times in the healthcare process.
Let’s recognize that patients are multidimensional people – the very people we created a health system to serve. The complexity of our healthcare system is placing increasing demands on people to perform well in all of their various roles. The most important thing is that we do our best to support patients in all of their roles as they do their best to navigate a relatively unfamiliar and multifaceted system!
 Press, Irwin. 2006. Patient Satisfaction: Understanding and Managing the Experience of Care (2nd ed.). Chicago, IL: Health Administration Press.
 Mayer, Thom A. and Cates, Robert J. 2004. Leadership for Great Customer Service: Satisfied Patients, Satisfied Employees, Chicago, IL: Health Administration Press.
Andrew S. Gallan, PhD is an Assistant Professor in the Department of Marketing at the Kellstadt Graduate College of Business, DePaul University, Chicago, IL. He can be contacted at firstname.lastname@example.org. Raffi Elchemmas is a second-year MBA candidate at DePaul University in Health Sector Management.
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