Buyers Beware

April 8, 2020

During my family practice residency one full day was dedicated to teaching us about practice management. It was a fanciful attempt to confer an adequate business education in one day. The residency program arranged for our class to be excused from all clinical (patient care) responsibilities and a variety of speakers were invited to share business concepts that might improve our chances of starting, joining and sustaining a successful practice. Speakers that I recall included a hospital administrator, a successful doctor, insurance salespersons, equipment vendors, a banker and a financial planner. The financial planner dispensed one bit of information that has stuck with me. He said, “Do not purchase advice from someone who has something to sell (when it can be avoided).” This advice has helped me through many confusing decisions in my life.

It seems fundamental in a capitalist economy that we seek to comprehend the motives of purchasers and sellers when we are one or the other of these parties. When we view explicit advertising we usually perceive that the advertiser is proud of their product or service. The sellers may think they have the best product or that they can convince buyers that their service for sale is superior. Many thoughtful potential customers turn to purported neutral analysts to compare available products. Sometimes neutral analysts are discovered to be influenced by more than just the customers who seek independent evaluations. Subtle advertising is often covert enough that consumers do not entertain the need to seek another opinion.

Advertising to prospective buyers who can purchase services to be paid by third parties adds another level of complexity to the “buyers beware” adage. Health care services are often paid by third party payers (e.g. insurance companies or government). Sellers may attempt to disconnect purchaser’s interests from the interests of the third party. Service venders are skilled at pitting the insurance company against the patient even when the company and the patient should be allied. In reality, the source of the third party’s treasure chest is composed of patients’ contributions. When third parties do not work to reduce or deny payment for some services, insurance premiums or taxes must go up for the payer to remain solvent.

Patients are advised to seek the best opinion when a healthcare service may be needed. Often, the perceived best opinion is delivered by a person who also performs the service. Patients frequently ask to see a specialist for a second opinion about a medical procedure. The specialist who renders the opinion also performs the procedure and thus, people seek advice from someone who has something to sell. My colleague physicians in many specialties are expert technicians who perform their services very well. In most cases they truly believe in the services they render. They are also paid well for those services. It may be difficult to find unbiased information, but one fundamental concept of capitalism seems to be largely ignored in healthcare.

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