RT Journal
A1 Myhre BA
T1 WOrds in "in a word"
JF JAMA
JO JAMA
YR 1999
FD January 27
VO 281
IS 4
SP 322
OP 323
DO 10-1001/pubs.JAMA-ISSN-0098-7484-281-4-jbk0127
UL http://dx.doi.org/10-1001/pubs.JAMA-ISSN-0098-7484-281-4-jbk0127
AB 
To the Editor: Dr 
Jackson1 makes a number 
of interesting points, but his definition of "customer" is not quite in keeping with the bottom
line–oriented medical philosophy of this day as practiced by some
groups. A customer is one who buys.2 At one time
all of us were paid fees or wages and from these we bought medical
care. Somehow this money was taken away from us in a paper transaction,
renamed "fringe benefits," and became money that the employer
graciously provides, and bargains to obtain medical coverage as cheaply
as possible. The customer of this new medical care is one's employer
or insurance company. The erstwhile patient is now relegated to a
damaged product that is to be
repaired. Therefore, the new term should be
"product." A parallel of this new outlook is the automobile sent to
the repair shop. The customer is the owner, and the provider is the
mechanic. No one asks the auto how it felt about the treatment or if it
was satisfactory. It is only a product owned by someone else. Customer
satisfaction surveys look good on paper, but the real customer
satisfaction is achieved when the payer finds a low-cost entry, not
when the patient feels that he or she has been treated satisfactorily.
Once we adopt this philosophy, managed care becomes much easier to
understand.