Kaiser Health News recently reported that Millennials (born between 1981 and 1996, currently 23-38 years old) are engaging the health care market differently than other generations. This is a subset of various observations about that generation.
Millennials have different preferences. Business Insider reports that Millennials are less engaged in the real estate market; CNBC reports they are less interested in diamonds; the Los Angeles Times reports that their view on buying cars is different ("complicated views" and "fundamentally different"). Reportedly, in a variety of other ways this generation differs from their parents. NBC News has reported that this generation is also simply more inclined to save.
In light of these many perceived differences, it is perhaps not surprising for the results of a Kaiser poll to support that this generation has different perceptions and engagement when it comes to medical care. The Baby-boom generation, and others before it, had embraced a medical model that was focused in some respects by the influence of a "primary care physician," or "family physician." This person was a starting point when illness or injury arose. Patients developed long-term relationships with providers.
Some of the prior generations' adherence to that model may have been driven by the health insurance industry. It is perhaps important to remember that health insurance came to America in about 1847, according to healthinsuranceproviders.com. There were plans that were involved with health care evolving during the Civil War, but the modern era began in the 1930s. And, there has been continued evolution over the last 90 years. Congress created Medicare in 1965. In 1973 a new model was created to challenge the typical indemnity health insurance policy model, it was called the health maintenance organization, or HMO. Some see the mandate of purchasing policies in Obamacare and the socialist campaign for Medicare for all as continuation of that evolution.
Kaiser Health News notes, however, that there is a significant population of Millennials that do not "have a primary care doctor," and do not "want one." Instead, there is some trend toward the "urgent care" or "walk-in clinic" model. Some see that as a "more convenient" alternative, noting that there "services are rendered in a quick manner.” The preferences and perceptions of this market segment is potentially important as there are about "83 million Americans" in that Millennial generation. Kaiser concludes this is "the nation's biggest generation."
Kaiser notes that the marketplace is responding to those perceptions and preferences. Service providers are marketing "a fast-growing constellation of alternatives," which includes clinics in existing retail environments, "urgent care centers" and "online telemedicine sites." For convenience, there may be little that compares with "seeing" a physician or other provider over the Internet from the comfort of one's own home. A Kaiser poll concluded that:
"45 percent of 18- to 29-year-olds had no primary care provider, compared with 28 percent of those 30 to 49, 18 percent of those 50 to 64 and 12 percent age 65 and older."
Kaiser notes that other surveys recently have demonstrated significantly similar results. Of course, it is also possible that the tendency toward identifying someone as "your primary care provider" increases as we age. In a broad perspective, perhaps young people are generally ill less often and therefore more likely to seek health care in an on-demand paradigm?
Telehealth is part of this perhaps. It is not a new topic, but this legislative session the Florida Legislature has been working on what it would mean here. House Bill 23 (HB23) in Florida involves tax credits, definitions, and more. The bill has cleared three committee stops in the House, and On April 29, 2019 the final version was passed and it will be presented to the Governor for consideration. This is one of several bills that may change healthcare in Florida specifically.
If signed by the Governor, then telehealth will become normalized to some extent in Florida. The bill includes definitions, treatment standards, constraints on some activity, and even a process for engaging physicians that are not licensed in Florida. With the Kaiser survey results in mind, it is perhaps likely that Florida Millennials will engage the process. Time will tell if it becomes normalized or compelling in Florida workers' compensation.
Interestingly, the bill includes a "venue" provision. The medical care is deemed by law to occur "at the place where the patient is located at the time the act is performed." Thus, although the physician may be located anywhere with access to the world wide web, the physician will be performing health care in Florida.
As the South Florida Sun Sentinel reported in April, there are some issues of concern to the medical community in telehealth. First, the providers are concerned with "payment parity." That means that when the provider interacts with a patient remotely, they want to be paid consistently with the in-person patient encounters. Florida providers had also expressed concerns with the participation of out-of-state health care practitioners.
There will also be concerns about the limitations of healthcare outside of in-person interaction. Is it necessary for the physician to depress the tongue and have us say "ah"; is it important to have our breathing heard through the stethoscope; do we need our ears examined? On the other hand, do patients need that in-person evaluation for a prescription refill? A persuasive example for telehealth was recently cited at a national conference I attended. It involved follow-up discussion with a patient after the in-person visit, discussion of reaction to medication, perceptions of improvement in condition, and saved the patient all of the inconvenience of returning to the doctor's office.
There will be continued evolution of this paradigm. Home diagnostic equipment has already evolved to allow data to be gathered on a computer or tablet. Blood sugar, pulse, temperature, blood pressure and more can be gathered in the home and seamlessly transmitted to the physician. There are platforms in use that allow doctors and patients to interact at will through texting, another favorite tool of Millennials.
Turning back to the Kaiser survey results and some perceptions of what drives the Millennial preference, both consumers and academics are quoted in the survey analysis. The common theme to their perspectives regarding disinclination toward a "primary care provider" paradigm is convenience. Sources for the article agreed that the Internet generally has facilitated Millennials' penchant for convenience. One contends that overall "people's expectations have changed," with convenience being a primary driver in many economic exchanges. The generation's preferences may be evidenced in examples like Uber, AirBnB, and other market "disruptors." Is telehealth any different?
Both the clinic model and telehealth are seen as providing that convenience, and avoiding the delay associated with awaiting a physician appointment; being seen more rapidly when there is illness. There are further convenience complaints regarding time spent travelling to the physician (a telehealth issue) and waiting in the doctor's waiting room (with sick people and contagion). Some complain of significant waits as doctors fall behind schedule. I have also heard complaints of patients who believe they actually contracted the flu or similar maladies while waiting in a doctor's office to be seen.
Thus there are critics of the commercial clinic model, however. and there is a broad tendency in favor of efficiency being demonstrated in a variety of service-delivery Internet platforms. Whether through the on-demand clinic paradigm or the telehealth paradigm, the Millennial desire for such services seems destined for at least some continued integration into the health care delivery process.
However, some contend that the primary care provider model is better at delivering quality care. A cited example involves a greater tendency toward unnecessary prescriptions for antibiotics outside of that model. Critics voice concern that such treatment is not helpful for the complaints and maladies, and worse may work harm on the patient.
A study published in a Journal of the American Medical Association (JAMA) concluded that "nearly half of patients who sought treatment at an urgent care clinic for a cold, the flu or a similar respiratory ailment left with an unnecessary and potentially harmful prescription," compared "with 17 percent of those seen in a doctor's office." The critics see an added value in the one-on-one relationship and the continuity of a consistent health care provider. Pause for a moment and consider that "17 percent" of those engaging a physician are given unnecessary and potentially harmful drugs. That is almost one in every five patients. Something to think about as you look around the waiting room next you are at the doctor's office.
The real take-away from all of this may be more basic: medicine is changing. Some of that change is likely the result of tools that are being added to the mix, such as telehealth. But, the information from Kaiser supports that some of that change is being driven by the desires of the consumers. And, while those consumer demands may be diverse and varied, when a character of service is desired by a large market constituent, like Millennials, there is likely to be reaction towards accommodating those preferences and desires. As the younger generations continue to grow and us old fogies fade, we may find our own choices dictated by those wants and desires also. We may be forced to accept new paradigms and processes.
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