Choice vs participation

Attended an interesting reception led by Todd Park , USA chief technology officer yesterday. The room was full of health policy analysts, technology companies and venture capitalists .  I had an interesting debate on the differences between the US and the UK in terms of engagement of patients in their health.

Although a massive generalisation , in the UK compared with the US, patients tend to be less engaged in their personal health planning.  This is certainly something that I have noticed working as a GP.  It struck me talking to my US colleagues about choice and voice that we have some big cultural hurdles to overcome. Offering options as we do with Choose and Book is an important prerequisite but it isn't the same thing as 'choice' which requires a willingness and ability to act on those options.  US patients are compelled to be actively involved in their choices even for the 45 million who aren't insured and whose options must at a time of illness be terrifying. The stark economic realities of American healthcare put it at the top of the agenda for every american family. The effect of this is high levels of participation but at what cost!

 

Making the economics of health closer to the patients has to be the right thing to do , the trick is doing that without adding to the emotional burden of illness by worrying about what things will cost.  I am left feeling that continuing to expose GPs to the economic footprint of their clinical decisions, one step removed from patients,  is the right direction of travel.  It will be interesting to see how personal health budgets develop for those who wish to take the next step.

 

In the collective we behave very differently however. UK communities engage quickly with any change in service design that we perceive as threatening to the NHS.  We debated the origins of this apparent paradox.   My american colleagues concluded that the luxury of personal disengagement is paid for by the comfort of an unchanging and ever present NHS that will provide.  I am not sure it's quite that simple  but what is clear is that we have to consider these important emotional responses when considering how to reconfigure services to make them better, safer and more sustainable as well as the facts and the logic. 

 

Mark Davies