The Effects of the Internet on Pharmaceutical Consumers and Providers

The Internet has changed healthcare practice and has just begun to influence pharmaceutical consumers and providers. The Internet firstly affects the pharmaceutical consumer through the five main functions it offers to all consumers of care. These functions are: (i) to provide and distribute information; (ii) to support informed decision making; (iii) to promote health; (iv) to provide a means for information exchange and support (the community concept) and; (v) to increase self care and manage the demand for health services, thus, lowering direct medical costs. Secondly, the Internet influences the pharmaceutical consumer by enhancing the move to consumer empowerment. Thirdly, it offers increased self-care capabilities to consumers through pharmaceutical information gathering and pharmaceutical products and services purchasing using Internet pharmacies. Finally, the Internet affects the pharmaceutical consumer by enhancing efficiency in the medical management of patients.It does this by providing the means for telemedicine and telepharmacy, by changing the healthcare professional-patient relationship, and by providing a tool for registering adverse drug events. Disease management benefits include: (i) access to care for remotely located consumers; (ii) the possibility of peer consultation and of access to diagnostic and therapeutic Internet information for healthcare providers; and (iii) continuity of care via virtual community networks, integrated health systems, interconnected, real-time, virtual healthcare teams, and virtual unified electronic health records. The Internet’s effect of increasing knowledge of illicit and unregulated drugs, which may change drug use behavior and drug culture, though, makes the medical management of patients less efficient.The effects of the Internet on the pharmaceutical provider firstly relate to technological and managerial changes. The Internet, secondly, induces changes in the provision of pharmaceutical care by offering the means for telemedicine, telepharmacy, and e-commerce, for advertising, promotion, and communication with consumers, and for supporting drug safety and pharmacovigilance.The Internet’s positive influence on pharmaceutical consumers and providers, however, mainly will depend on whether proper solutions can be found for the privacy/security and confidentiality problems existing in pharmaceutical information gathering and pharmaceutical products and services purchasing. Special focus should be placed on ensuring the privacy of consumer information and on the secure transmission of financial information. The best defenses will be adequate, national, international, and global laws and regulations which ensure privacy/security and confidentiality on a global level.     

Digital health care--the convergence of health care and the Internet

The author believes that interactive media (the Internet and the World Wide Web) and associated applications used to access those media (portals, browsers, specialized Web-based applications) will result in a substantial, positive, and measurable impact on medical care faster than any previous information technology or communications tool. Acknowledging the dynamic environment, the author classifies "pure" digital health care companies into three business service areas: content, connectivity, and commerce. Companies offering these services are attempting to tap into a host of different markets within the health care industry including providers, payers, pharmaceutical and medical products companies, employers, distributors, and consumers. As the fastest growing medium in history, and given the unique nature of health care information and the tremendous demand for content among industry professionals and consumers, the Internet offers a more robust and targeted direct marketing opportunity than traditional media. From the medical consumer's standpoint (i.e., the patient) the author sees the Internet as performing five critical functions: (1) Disseminate information, (2) Aid informed decision making, (3) Promote health, (4) Provide a means for information exchange and support--the community concept, and (5) Increase self-care and manage demand for health services, lowering direct medical costs. The author firmly submits the Web will provide overall benefits to the health care economy as health information consumers manage their own health problems that might not directly benefit from an encounter with a health professional. Marrying the Internet to other interactive technologies, including voice recognition systems and telephone-based triage lines among others, holds the promise of reducing unnecessary medical services.     

Health care costs: the other point of view

Health care delivery in America is not efficient. Hospitals are not efficient and many are still wasteful. Some of the most blatant wastes in hospitals are staffing patterns that developed during the years of cost reports. Spending patterns become the norm, rather than excess, when they continue unabated for years. There are many reasons for cost increases in health care and specifically in hospitals. However, it is difficult to make these reasons add up to the total cost increase. No one has the answers; observation can only be made of what has been occurring and what continues to occur. Whatever the reason for the increase in health care costs, the consumer will bear the burden because of the circular flow of income and expenditures between the business sector and the household sector. Increased health care costs are passed on to the consumer in the form of increased expenditures for household goods and services or taxes. Ford Motor Company President Mr. Peterson says that $1,500 of every new automobile represents employee health care costs. The American consumer created the demand for health care services, and only the consumer can control the demand. One solution would be to let the consumer bear health care costs directly and remove the inefficiencies created by third party insurance carriers. This hypothesizes that the health care consumer is the most efficient shopper for health care services, and that third party insurance carriers are an important source of inefficiency in the health care delivery system. Many other solutions have been proposed by the government and by the insurance and health care industries, but most have only increased the cost of health care. Perhaps some day the health care industry will learn how to control the dynamics of this four-party purchasing decision. Until then, costs will continue to grow dramatically, and the executives of the industries who compete in the two-party purchasing system will wonder why the process is so complicated.     

Self-Managed Care

Abstract

This article discusses the need for a partner in the managed care system that meets the health information needs of the consumer that physicians and hospitals do not provide. It introduces Health World Online (http://www.healthy.net), a Web-based integrated consumer health resource where end users can find accessible health information. The Internet plays a key role by allowing users to make the kinds of personal choices that will help them achieve real health—which is at the heart of the transition to self-managed care.     

Appraisal Skills,Health Literacy and the Patient-Provider Relationship: Considerations as the Health Care Consumer Turns to the Internet to Inform their Care

Health care consumers increasingly obtain health information from the Internet to inform their health care; the health care consumer, who also has the role of patient, maintains the right to access information from sources of their choosing for this purpose. However, noteworthy considerations exist including information appraisal skills, health literacy and the patient-provider relationship. Awareness and education are warranted to assist the health care consumer in achieving proficiency as they turn to the Internet for health information.     

Expanding Internet access for health care consumers.

Sophisticated health care consumers are beginning to use the Internet to educate themselves about their own health and manage their own care. As health care stakeholders (providers, payers, employers) feel pressure from consumers to implement Internet-related strategies, stakeholders must realize that obtaining Internet access is a challenge for many consumers. Stakeholders who expand consumer Internet access will, however, have a competitive advantage. This article outlines how stakeholders can expand consumer Internet access.     

The importance of patient empowerment in health system reform

Health system reform is on the agenda in Australia, across Europe and North America and elsewhere. Reform is being driven by attempts to meet ever increasing health service demands in the face of cost containment pressures. There is little agreement concerning the preferred features of health funding models. A micro-economic framework is used to define universal performance characteristics for optimal health funding arrangements. Two principle requirements emerge. These are (1) demand side reform to empower consumers and (2) supply side reform, to promote opportunities and incentives for a responsive service system and competition amongst providers. A focus on supply side issues only, without recognition of the fundamental importance of consumer empowerment will fail to promote an efficient solution to the distribution of health resources. Mechanisms to promote active consumer involvement in health care decisions are identified as a central requirement in health system reform.     

Getting Acquainted with Support and Self-Help Groups on the Internet

Abstract

The combined influence of the consumer health care movement, economics, and the communications revolution (specifically the Internet) promise to radically influence the manner in which the health care industry provides services to the American public. These forces are expected to spawn a more sophisticated consumer who will ask questions, collaborate in treatment options, and readily explore all the alternatives before making a decision. The near limitless possibilities for consumers to network using the electronic resources of the Internet are in the earliest stages of development. The purpose of this article is to briefly define the purpose of support or self-help groups, provide information on how to access them through the Internet, and offer suggestions for criteria that consumers may want to consider in determining the quality and value of these groups.     

Contemporary models of change in the health professions

This article reviews the special position that health professionals have occupied and the ways in which changes threaten the foundations of professional work. The application of modern management principles to health care runs the risk of overriding the "action orientation" that is a defining component of professional work. One goal of health workforce design should be the engineering of opportunities for the preservation of "professional voice" as a countervailing force to ensure high quality health care. Contemporary models of change applied to health care workforce include: (1) the system of professions models in which securing and maintaining jurisdiction are the mechanisms that professions employ to sustain their position, (2) a strategic adaptation model by which professions attempt to adjust to changing environments, (3) a model of redesigning patient care which applies Total Quality Management (TQM) and other "industrial techniques" to the health care workplace, and, (4) model of "consumer sovereignty" in which groups of citizens come together to determine the nature of care services and professional work, with the participation of the organizations and providers.     

The changing face of health care management

In health care as elsewhere, the only constant is change. Change has been especially rapid in health care, forcing dramatic changes in the way health care managers work. Management style in health care may or may not be different from that in other industries; its determinants are related primarily to certain universal characteristics that may be present in many businesses but have one dimension in common: immediacy of the customer (that is, hands-on, face-to-face service). Health care management has had to change considerably in the past 30 years and will be required to change further still in the years to come. In changing with the industry, the role of the health care manager will include enhanced span of control and increased authority and responsibility, and thus greater accountability. Given the changing nature of the environment, the most valuable characteristics of tomorrow's health care manager will be flexibility and adaptability.     

How does searching for health information on the Internet affect individuals' demand for health care services?

The emergence of the Internet made health information, which previously was almost exclusively available to health professionals, accessible to the general public. Access to health information on the Internet is likely to affect individuals' health care related decisions. The aim of this analysis is to determine how health information that people obtain from the Internet affects their demand for health care. I use a novel data set, the U.S. Health Information National Trends Survey (2003-07), to answer this question. The causal variable of interest is a binary variable that indicates whether or not an individual has recently searched for health information on the Internet. Health care utilization is measured by an individual's number of visits to a health professional in the past 12 months. An individual's decision to use the Internet to search for health information is likely to be correlated to other variables that can also affect his/her demand for health care. To separate the effect of Internet health information from other confounding variables, I control for a number of individual characteristics and use the instrumental variable estimation method. As an instrument for Internet health information, I use U.S. state telecommunication regulations that are shown to affect the supply of Internet services. I find that searching for health information on the Internet has a positive, relatively large, and statistically significant effect on an individual's demand for health care. This effect is larger for the individuals who search for health information online more frequently and people who have health care coverage. Among cancer patients, the effect of Internet health information seeking on health professional visits varies by how long ago they were diagnosed with cancer. Thus, the Internet is found to be a complement to formal health care rather than a substitute for health professional services.     

A critical analysis of the literature on the Internet and consumer health information

A critical review of the published literature investigating the Internet and consumer health information was undertaken in order to inform further research and policy. A qualitative, narrative method was used, consisting of a three-stage process of identification and collation, thematic coding, and critical analysis. This analysis identified five main themes in the research in this area: (1) the quality of online health information for consumers; (2) consumer use of the Internet for health information; (3) the effect of e-health on the practitioner-patient relationship; (4) virtual communities and online social support and (5) the electronic delivery of information-based interventions. Analysis of these themes revealed more about the concerns of health professionals than about the effect of the Internet on users. Much of the existing work has concentrated on quantifying characteristics of the Internet: for example, measuring the quality of online information, or describing the numbers of users in different health-care settings. There is a lack of qualitative research that explores how citizens are actually using the Internet for health care.     

Marketing and pricing strategies of online pharmacies

Internet and e-commerce have profoundly changed society, the economy, and the world of health care. The web offers opportunities to improve health, but it may also represent a big health hazard since it is a basically unregulated market with very low consumer protection. In this paper we analyze marketing and pricing strategies of online pharmacies (OPs). Our analysis shows that OPs use strategies that would be more suitable for a commodity market than for drugs. These strategies differentiate according to variety (brand or generic), quality, quantity, and target group. OPs are well aware that the vacuum in the legislation allows them to reach a target of consumers that pharmacies cannot normally reach, such as those who would like to use the drug without consulting a physician (or, even worse, against the physician's advice). In this case, they usually charge a higher price, reassure the users by minimizing on the side effects, and induce them to bulk purchase through sensible price discounts.This analysis suggests that the selling of drugs via the Internet can turn into a “public health risk”, as has been pointed out by the US Food and Drug Administration.     

Catching the Web-Casting Wave

Abstract

The Charleston Area Medical Center (CAMC) in Charleston, West Virginia has embraced new media technologies to raise the bar on Web-based consumer information. This paper will detail CAMC's initiative in the area of interactive, Web-based consumer health learning using Web casting. CAMC has learned how to put their video programs on the Internet to teach people how to make the best health decisions. The professionals at CAMC are pushing the limits of what can be done with health information on the Internet.     

Consumers of health information and health care: challenging assumptions and defining alternatives

The end of the 20th century saw a sea of change in the view of individuals in relation to their health and health care. The term "consumer" began to be used to describe myriad new roles and responsibilities for lay people who receive health services and who are often the target of health promotion and disease prevention interventions. This article (1) describes how the term "consumer" is used by various stakeholders in the health care sector; (2) specifies the assumptions that underlie the notion that a "new" kind of health care consumer can (and should) have a significant effect on their own health and on the health care system; (3) challenges the evidence base of these assumptions, noting that many are either unsupported or clearly contradicted by what we know; (4) articulates a set of principles to inform an alternative, more productive, and feasible role for individuals with respect to their health and health care; and (5) identifies the implications of those principles for health promotion and health care professionals in the 21st century.     

Health care consumer reports: an evaluation of employer perspectives

The proliferation of health care consumer reports (also known as "consumer guides," "report cards," and "performance reports") designed to assist consumers in making more informed health care decisions makes it vital to understand the perspective of employers who provide the vast majority of health insurance to the working population regarding the use of these reports. There is little empirical evidence on how consumer reports are used by employers to make health care purchasing decisions. This study fills that gap by surveying 154 businesses in Boone County, Missouri, regarding their evaluation of a consumer guide. The majority of employers surveyed indicate that the report will not have a direct effect on their health care purchasing decisions. However, they indicate that the reports are "positive and worthwhile" and their responses reflect a favorable view of the health care organization that developed and disseminated the report. Additionally, findings indicate that employers generally prefer consumer reports as a means to compare local health care institutions, rather than reviewing national averages to locate the same information. Report developers should take precautions to determine the intent of such reports, as they may not achieve the objective of changing employers' health care purchasing behavior.     

A framework for assessing health systems from the public's perspective: the ALPS approach.

There is hardly a country in the world where the health system is not undergoing major changes. Low- and middle-income countries are particularly hard hit by enforced reforms and commercialization. The overwhelming focus of assessment of these reforms has been on the supply side: effects on governments and providers. Yet the raison d'être of health services is to serve people when in need, and most systems have the equity objective of ensuring the widest possible access to essential services for the whole population, and poor people in particular. The Affordability Ladder Program (ALPS) is a tool for analyzing health systems from the public's perspective--the so-called "demand side," which the authors prefer to consider in terms of "need" for care. ALPS is concerned with how social inequities in health care are experienced by people in different sections of society. By taking a step-by-step approach to examining the many aspects of a health care system from a household/patient perspective, one can more accurately pinpoint where and why a country's health system is working and where it is breaking down, and identify the sticking points that need to be addressed by reconsidering present policies and initiating new ones to promote efficient, equitable health care systems.     

Patients meet technology: the newest in patient-centered care initiatives

In recent years, health care consumers have become increasingly sophisticated in their selection and use of health care services. Empowered initially by the Internet, they are seeking medical information to become better informed as they interact with physicians and other health care providers. This article addresses (1) the new patient-provider relationship with more provider accountability, the impact of Baby Boomers on health care, and the evolving consumer-driven marketplace with emerging patient-centered care; (2) emerging technologies being used to transform the patient experience; (3) how the use of cutting-edge technologies affect the health care consumer; and (4) the future impact of the use of patient-centered technology initiatives on the health care industry. The personal health record is predicted by experts to be the primary technology that will promote advancement of the electronic health record; therefore, this article focuses on patients' use of the personal health record.     

Consumer‐Oriented Health Care Reform Strategies: A Review of the Evidence on Managed Competition and Consumer‐Directed Health Insurance

Context: For many years, leading health care reform proposals have been based on market‐oriented strategies. In the 1990s, a number of reform proposals were built around the concept of “managed competition,” but more recently, “consumer‐directed health care” models have received attention. Although price‐conscious consumer demand plays a critical role in both the managed competition and consumer‐directed health care models, the two strategies are based on different visions of the health care marketplace and the best way to use market forces to achieve greater systemwide efficiencies. Methods: This article reviews the research literature that tests the main hypotheses concerning the two policy strategies. Findings: Numerous studies provide consistent evidence that consumers’ health plan choices are sensitive to out‐of‐pocket premiums. The elasticity of demand appears to vary with consumers’ health risk, with younger, healthier individuals being more price sensitive. This heterogeneity increases the potential for adverse selection. Biased risk selection also is a concern when the menu of health plan options includes consumer‐directed health plans. Several studies confirm that such plans tend to attract healthier enrollees. A smaller number of studies test the main hypothesis regarding consumer‐directed health plans, which is that they result in lower medical spending than do more generous plans. These studies find little support for this claim. Conclusions: The experiences of employers that have adopted key elements of managed competition are generally consistent with the key hypotheses underlying that strategy. Research in this area, however, has focused on only a narrow range of questions. Because consumer‐directed health care is such a recent phenomenon, research on this strategy is even more limited. Additional studies on both topics would be valuable.