¶ … Business Terminology in Health Care The Health Care Industry, idealistically is a large conglomeration of helping individuals and organizations who's sole purpose is to help people become more healthy, be that through prevention of disease or treatment of disease. Yet, it is known among nearly all health care professionals and almost all people who have ever been treated in the health care industry, even in the most minor way, which includes nearly all of the population, that the "Health Care Industry" is just that, an industry. This industry is governed by profit and loss just as any other; possibly even more so in the sense that the more loss there is the less people can be helped.

Over the past fifty years, as technology expands and costs rise there has been a noticeable change in health care delivery, for better and for worse most would say.

Change in the United States is being driven by rising costs, the failure to provide universal coverage, consumer dissatisfaction, and the increasing recognition that the country has poor life expectancy and high infant mortality despite an expenditure on health care far higher than any other country. (Savage 1997-page 1495)

The most notable change for most patients is the impersonal nature of health care delivery. The rising cost of health care, scarcity of labor, consumerism, competition driving down profits, limited access to capital are all considered the greatest challenges to health care in the next few years. (Redd & Kongstvedt 2004-page 36)

The reasons for these financial pressures are varied and well-known: an aging population; demanding consumers; increased utilization, particularly for pharmaceutical and hospital outpatient services; increased regulation and benefits mandates; rising malpractice awards and premiums; variations in practice and medical errors; and new technological advances, such as drug-eluting stents, genomics for health screening, and specialty pharmaceuticals. So if financial pressures have plagued the industry for years, what will be different in 2004? Put simply, what is new is the magnitude of the problem. The costs are higher and frustration levels are greater than ever. (Redd & Kongstvedt 2004-page 36)

These issues compounded by consumer demands are the woes of the health care industry. Those providing care and those administering organizations and hospitals are all being made more and more aware of the problems, and as a result so are patients. Yet, the answer can simply not be the consumer needing to lesson demands, as the capitalistic economy requires such pressures to increase quality. So, should the patient embrace his or her role as consumer, and how willing are they to do that?

Fifty years ago, though less was known about nearly everything involving treatment of disease, health care was a more personal experience. You really knew your doctors and nurses and in many cases you had a clearer understanding of the work they were performing in an attempt to help you heal and if this wasn't the case you at least had a more personal level of trust for those providing your care.

People spent significantly more time in the hospital, when receiving treatment and therefore a much greater amount of time getting to know their providers.

The 32.7 million patients in the nation's hospitals 2001 had a much shorter average stay (4.9 days) than patients in 1970, who were hospitalized for an average of 7.8 days, according to the National Hospital Discharge Survey from the Atlanta-based Centers for Disease Control and Prevention. (CDC 2003 p S1)

The rapidly changing health care system has caused patients to balk at service and the impersonality of it, physicians and other providers to lament being unable to provide care in the way they would like to and even stress to both providers and patient when problems fall through the cracks because of limited time for consultation and care. Even the buildings themselves are being redesigned as a response to consumerism. (2001 International Conference and Exhibition on Health Facility Planning, Design and Construction 2001 pages 12-13) Pressures from insurance companies and administration seem to be dictating the quality of care for the patient, even health care risk-management traditionally a department that oversaw safety and incident reduction is now responsible for insurance compliance. (Chordas 2004 pages 25-28) Yet, there must be some middle ground for the patient, some assurance that the physician and all his support staff are acting in their best interest.

When patients in a health plan negotiate for better terms and conditions or clients lobby for better coverage from the Medicaid program, health care is a business and patients are customers. But when...

(Klint 2002 page6)
In response to all this many people both as recipients and deliverers of care are demanding reform, a reaffirmation of the social contract associated with the best interest of the patient, regardless of cost. For the health care recipient the demand has often come in the form of consumerism. (Segal Executive Letter 2003-page 3-4) Patients are demanding informative choices about their care, and cost effective care. In this demand is a hidden by-product.

The changes in health care delivery have made the recipients and deliverers more and more aware of the business of health care and the response seems to be that if it is going to be recognized as a business by providers and recipients alike, but especially by administration and insurance agencies than recipients must begin to take on the role of the consumer rather than the patient. Doctors are often forced to look concerned family members in the eye and say, "Well, how much are you willing to spend to save your father's, mother's, daughter's, son's, husband's, wife's life?" Or "Do you want to be paying for this for the rest of your life?"

This work is a proposed explorative study that will analyze the terminology used in health care to refer to the consumer and the provided services. Research associated with the use of business terminology in the health care delivery system is almost non-existent, simply because so many years have been spent trying to disprove the theories that the health care industry, at least on the provision end is a business. Yet, many are repeatedly disappointed by their expectations of the best possible care regardless of the business parameters of delivery. "We struggle to keep business decisions separate from clinical ones. We don't want cost to influence delivery." (Solovy 1999-page 30) Some have responded with an attempt to create a humanistic capitalism that respects the greater needs of the community and the individual as well as respecting spirituality, yet this seems to be a difficult pill to swallow for consumer driven organizations, regardless of their mission statements. (Kaiser 2000, pgs.6-13)

This work will attempt to gather the psychosocial effects of the use of business terminology in the health care industry. The research team would like to understand the psychological effects of referring to health care delivery as a business in terminology as well as reality, the delivery of services to a consumer with all the responsibilities of it.

Methodology:

Research Questions:

What are the perceived psychological effects of the use of business terminology in the health care delivery system?

Would patients prefer to be thought of an treated as consumers in the delivery of health care or would they prefer to be seen as the traditional patient, with personal needs with regard to their greater health?

Would health care providers be offended if they were informed of their physician's role as a worker and wage earner in the delivery system?

Do patients already see signs and symptoms of their care as a consumer service and how do they feel about it?

Will consumerism help or hurt the health care industry in the long run?

The work will survey a group of consumers using a questioner in a voluntary study. The participants will be gathered randomly from telephone listings in the study group area, the greater Portland, ME area. The study will ask consumers their feelings about reference to business terminology within their health care delivery. Each participant will be given an informed consent briefing, informing them of the type of research questions being asked and the proposed use of the information, including the name of associated organizations conducting the survey and the potential for possible publication in a scholarly medical journal in the future. The survey will be anonymous and will therefore not require the name of the consumer surveyed, yet general demographic information will be gathered for a better understanding of the sample studied.

The survey will be conducted via telephone, with the enlisted help of a local telephone survey company.

The main attraction of telephone interviewing is that it enables data to be collected from geographically scattered samples more cheaply and quickly than by field interviewing, but avoids the well-known limitations of postal surveys. Other advantages are: that interviewing from a central telephone unit lends itself to careful supervision and control; and that it is possible…