On its current trajectory, the American healthcare system will increasingly place the primary responsibility for managing one’s own healthcare on the consumer. For better or worse, when navigating the healthcare system, consumers are the ones at the wheel.

The challenges associated with consumers doing the driving on their healthcare journeys are extensive. They will encounter multiple roadblocks along the way that will sabotage their chances for success. First and foremost, education is an enormous obstacle in most cases. Not only do consumers need to take the time to learn about the healthcare system, their health insurance benefits (if they are among those who have coverage), health conditions, and treatment options but they also need to have the ability to find and interpret performance and quality data, review outcome results, and examine cost information to make purchases based on value. All of which needs to be done within an endless mire of acronyms, terms, and buzz-phrases couched in insider jargon. And this is all assuming that consumers even know that they are the ones driving the bus in the first place.

In Dale Shaller’s article in the October issue of The American Journal for Medical Quality ,he explores this topic by asking whose responsibility it is to make sure that consumers are engaged in managing their healthcare.

"For consumer engagement to become a reality, and not just the latest catchphrase in the ongoing litany of health care reform rhetoric, we will need to see concerted aggressive action on the part of multiple stakeholders that are in a position to help consumers and patients assume the wide range of personal responsibilities increasingly expected of them."

Of course there are some substantial upsides to consumers taking on the challenge of managing their own healthcare. No one has a more intimate knowledge of the patient’s health than the patient. The consumer knows things in a way that a provider often cannot. Certainly no one has a more vested interest in a positive outcome than the patient. In an ideal world, a consumer assumes a collaborative role with providers to successfully drive positive health outcomes. However, the current reality requires the consumer to shoulder the majority of the weight, and the current environment makes the load nearly impossible to bear. The system needs change. Shaller suggest employers should play a key role, and cites several good examples of ways employers have creatively engaged employees to effect better outcomes. But most of these are large employers - what about the employees of small organizations? What about the unemployed? Shaller suggests the physician will need to be a key player if this transformation is to occur. Clearly, more efforts need to be made in getting all stakeholders to work together.