Patient or Consumer: Implications for the Canadian Health Care System

Rationale: Patient comes from the Latin word 'patientem' meaning suffer. It is defined as a person having or showing patience, a person receiving (or registered to receive) medical treatment. Consumer comes from the Latin word 'consumere' which means to take completely. In economics a consumer uses a good to satisfy his wants. What are the implications of the use of these two terms in the dynamic health care market in Canada? Objective: The objective of this paper is to examine the literature on this topic and address the implications of framing health care users as either 'patient' or 'consumer' on the health care landscape in Canada. Methodology: The literature on the implications of using the terms patient or consumer was searched in Medline. The references of appropriate articles were also searched. The Romanow, Mazankowski, and Kirby Reports commissioned by governments in Canada were also examined to identify the relevant context for the publicly funded Canadian health care system. Finally, the use of the terms patient and consumer in the literature on the debate over private and public health care in Canada was examined. Results: The literature indicates consumer can mean autonomous decision-maker or purchaser. The first meaning has implications in health care. Can the autonomy of a patient be different than the autonomy of a consumer? Do consumers have different than patients? The players in the health care market can also have different incentives from those in other markets. The framing of patient versus consumer also has implications for the role of physicians. Physicians are not simply sellers of healthcare; they have professional and ethical obligations that providers in other markets do not have. A producer's goal is to maximize profit and has no ethical obligation to act with consumers' best interests in mind. This framing also has implications at a policy level in health care. The Romanow, Mazankowski, and Kirby Reports are all attempts at addressing this shift in the context of the Canadian health care system. The Kirby Report directly addresses the issue of patient/consumer rights in health care. It indicates that the current prohibition on private financing and supplementary private insurance may be contrary to the Canadian Charter of Rights and Freedoms. In 2005, an unprecedented case that made this claim was decided upon by the Supreme Court of Canada. The case dealt with patients' inability to receive timely care and giving patients more options; a case of instilling more consumer 'rights' in the market for health care services. Conclusion: Over the past four decades there has been a gradual shift from consistently referring to those who are under the care of medical professionals as patients to sometimes referring to them as consumers of health care. With this change has come a recognition of the incentives implied by these terms and their effects on the actions of individuals and the health care market. Concurrently and perhaps not coincidentally, some have called for more private involvement in the health care market in Canada.

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