The Dark Side of a Consumer-Driven Health System

By Rodwin, Marc A. | Frontiers of Health Services Management, Summer 2003 | Go to article overview

The Dark Side of a Consumer-Driven Health System

Rodwin, Marc A., Frontiers of Health Services Management

UNCHECKED, PROFESSIONAL sometimes shortchange the rights of patients and interests of consumers and the public. Medical consumerism can help rein in the paternalism and self-interest of professionals. Proponents of medical consumerism argue that it will lead to more responsive organizations and to better quality, service, and prices. Providers of medical care can take account of the consumer perspective, increase information for consumers, and promote patient and consumer choice and participation in decision making. The articles by Julie Morath and Quint Studer show some of the benefits of medical consumerism and explain how consumer-oriented management can improve the quality of healthcare.

Elsewhere, I have explained that strengthening the consumer voice is a neglected remedy to promote healthcare change (Rodwin 1997) and looked at the potential as well as the obstacles for the growth of a consumer health movement (Rodwin 1994, 1996, 2001). Consumerism may also help check the conflicts of interest of professionals (Rodwin 1993). Morath, Studer, and I agree, then, that the healthcare system should focus on the individuals who receive or need health services. We also agree that medical consumerism has great value, which is only partially tapped. The perspectives of patients and consumers were neglected for most of the twentieth century. However, over the last two decades the tide has shifted. Health managers and policymakers now generally acknowledge the importance of the consumer in healthcare. The readers of this journal too, I suspect, are either proponents of furthering medical consumerism or are sympathetic to the idea. However, if we adopt a full consumer model for our healthcare system, we will incorporate not only the positive elements of consumerism but some negative ones as well. These negative aspects are often overlooked by proponents, so in this commentary I will explore the dark side.


When we think of patients as healthcare consumers, we promote the idea that healthcare is a market service purchased by individuals, just like any other. That metaphor works well in some contexts, but not in others. If we forget the limitations of the consumer metaphor, it will distort our thinking about medical care, and we will not be furthering the interest of patients or the public.

Healthcare is not solely a matter of individual market choice and personal responsibility. Health is at the core of our social welfare, and it is the product of public policy as well as the private sector. The manner in which we organize our health system reflects our social bonds. How we provide health services can promote or weaken social solidarity and public spirit. Therein lies the rub. Thinking of healthcare as a consumer issue may reduce our sense of social obligation to provide medical services for those who lack means. In the name of promoting consumer choice, we may open up options only for individuals who have ample resources. A consumer model may encourage the idea that healthcare professionals or organizations have little or no obligation beyond engaging in activities that promote their return on investment. We may also forget that when markets do not provide the outcomes we want, we can use public policy and governmental programs to achieve those ends.

We need to consider what it is about a consumer health model that we like and whether it is possible to develop these aspects without the less-desirable features of consumerism. There are four aspects of consumerism that I think we should avoid: two address patients, and two speak to providers. These are noted below in the propositions about a consumer model of healthcare.


If You Don't Have Any Money, You Won't Get Any Service

Consumers only purchase what their budget allows, and many people cannot afford healthcare. Should we treat healthcare insurance as an item to be allocated based on ability to pay?

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Cite this article

Cited article

Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)


1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25,

Cited article

The Dark Side of a Consumer-Driven Health System


Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25,

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.