They're not words we usually associate with health care—  "retail," "wholesale," and "competition"—but they may be the biggest factors in how we receive and pay for health services in the future, according to researchers.

The research firm Booz Allen Hamilton suggested in a report released in July that medicine, like other parts of the economy, may be feeling the effects of "the fundamental forces at work in retail consumer markets—supply and demand."

So far, most purchasing decisions in the U.S. health care system have been "wholesale," made by large operators such as HMOs and insurance plans that give consumers limited or no choice about where they can go, and whom they will see, when they need medical help. But researchers speculate it may now be time to give consumers information so they can choose—"shop"—for health care in the same way they do when buying a car. That would make health care a "retail" operation—sometimes called "consumer-driven" care.

Early signs of an evolution from the wholesale model include walk-in clinics, personalized concierge health care, consumer-directed health plans, remote monitoring of patients' health conditions, and care delivery by nonphysician professionals.

We're still in the early stages of a transition, if it is going to happen, Booz Allen notes, but it might be a good idea for physicians and other health care providers to be aware that change may be coming. So far, it is mostly people with high-deductible health plans who are beginning to act like retail consumers, comparing cost and quality in their health care options, and it's hard for even those consumers to get trusted information about providers and suppliers.

Doctors interviewed for the study placed consumerism at the top of the list of issues they expect will affect their practices over the next three to five years, equal to or exceeding other much-talked-about possible developments, such as "pay-for-performance" or "evidence-based medicine." Fewer than 20 percent of the doctors thought, however, that giving consumers choice would produce better outcomes or make patient-physician relationships more rewarding.

And because physicians so far seem unable or unwilling to provide the information consumers are likely to want about cost, quality, and service, that may lead to opportunities for "new intermediaries" who will provide such information. Whether those intermediaries would include current stakeholders who have traditionally served in information-providing roles—health plans and the government, for example--remains to be seen.

What the research so far shows, according to Booz Allen, is that we need more research-- to help us understand a possible sea change in health care delivery and to help consumers use information, make decisions, and change behavior.

Information about the survey, "Consumer and Physician Readiness for a Retail Healthcare Market" is available on the Booz Allen Hamilton website, at www.boozallen.com.

WORTH NOTING

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