Q: Can the patient be a responsible health care consumer?

A: As the current health care situation places more responsibility in the hands of consumers in terms of hygiene and social relationships, we need to trust one another. In doing so, there are important points to keep in mind. An Aetna study estimates that as much as 40% of premature mortality in the U.S. is due to health behavior. The CDC states that 20 to 30% of prescriptions are not even filled by patients. The Journal of the American Medical Association ranks the U.S. as having the highest rate of obesity among the 11 highest-income countries in the world. This is a snapshot of health behaviors that do not bode well for the patient becoming a trusted health care consumer.

Efforts are being made to push costs back to the patient in terms of insurance deductibles and health savings accounts. Social spending on health-related programs hopes to engage the elderly and the poor in better health habits. Personal digital health information makes patients more aware of the benefit of sound health decisions. Yet, the irresponsible health behaviors persist. One must wonder why these interventions have not been more powerful in shaping healthy behaviors. The answer may be found in examining what makes us truly human.

David Freeman, in a July 2019 article in the Atlantic, addresses the root of poor health behaviors. He cited lack of community norms, anger of patients over treatment, and flagrant disregard for routine care. These are human traits that might be best addressed through social associations. It is through those associations that people find purpose, i.e., reasons to make healthy choices.

Self-neglect finds common cause with tens of millions of American patients. These are people who rely on “for itself” decisions about eating, smoking, drinking, etc. Behavioral economists, financial incentives and technology can help these people move toward healthy behaviors only if they establish a purpose to do so. Paying attention to social associations might move consumers toward more responsible health behaviors. The current pandemic has demonstrated the need for social norms and the willingness for people to comply. Now, the question is if that mind-set can be sustained.


Jack Militello is a professor of management at the University of St. Thomas Opus College of Business.