News & Insights

News & Insights


A vision for the next decade should be inherently optimistic. None of us want to consider the possibility that our kids will have a lower standard of living than we have, or that life expectancy will decline, or that our society will continue to devolve into warring tribes, rudeness, and incivility. See? One sentence and we all feel worse about ourselves. Not my purpose, but you get the point.

Yet, an accurate prediction for the next decade requires an honest appraisal of the last decade. And as we lay out in Joe Public 2030, by all accounts, consumers face more hurdles to real choice in healthcare today than perhaps any time in the last five decades. With our first prediction, “The Copernican Consumer,” we anticipate choices for care outside a regular hospital setting to increase exponentially. But the other side of the coin is our second prediction, where the “Constricted Consumer” faces a consolidated marketplace, narrow networks, more providers out of network, and huge financial consequences when they make the “wrong choice.”

What is the Constricted Consumer?

Here is the high-level summary of the “Constricted Consumerism” prediction: “While consumers will become increasingly responsible for their own health and use of healthcare services, they will actually become less and less empowered in the choices they have for care, especially in higher-acuity, higher-cost situations. While many in the industry will continue to sing the praises of choice, the reality is most consumers will have far fewer choices moving forward, often in ways they might never ever consider or see.”

So, let’s spend a moment looking at the trends that have converged to constrict access and choice, as well as what the next decade may bring.

Constricting via consolidation

The popular villain in this story is hospital consolidation. Business media, urged on by sophisticated and relentless health plan PR operations and their think-tank proxies like RAND, have pinned the blame for rising healthcare costs and limited choices solely on hospital consolidation. Yet, an honest assessment of the causes forces us upstream – why do hospitals consolidate in the first place? True, some health systems acquire competitors solely to build market share and command higher prices. Yet, the vast majority of the consolidation can be explained by payor behavior – when big, dominant payors force smaller hospitals and health systems to accept artificially low payment rates for their services, those hospitals will eventually need to seek larger partners to protect them and keep their doors open. These smaller hospitals seek the “safety of the herd,” where payor rates are negotiated centrally by the larger entity.

Consolidation can indeed constrict choice very often as the consolidator eliminates redundant services and the attendant costs for maintaining those services at hospitals that previously competed prior to joining forces. We have seen this trend in the starkest terms when we watch the rural landscape in America.

Perhaps rural decline is causing hospitals to close, or hospitals closing is causing rural decline – the causes and effects have become circular. What we know is that some of this constriction for consumers is too late to reverse, and we must plot a future that reduces constriction rather than continues the trend.

Payors play a part

The other real villain in this story is the deliberately complex and constricting narrow networks, payor policies, tiered networks, and other strategies specifically designed by payors to constrict access and consumer choice. Often, these same payor strategies punish consumers financially when they choose where they want to go without checking all the obscure restrictions, or when they fail to secure prior authorization, or just when the payor says “Mars is in retrograde.” I made that last one up (I think) but I wouldn’t be surprised to see it in a United Healthcare benefits plan booklet.

It’s undoubtedly true that the problem of health equity contributes to the Constricted Consumer too. Discrimination adds another layer of constriction that Black, brown, and LGBTQ+ face (subtle and often overt). In addition, there’s the socio-economic barriers such as food deserts, poor public transportation, and limited access to primary and urgent care that could add additional layers of constriction. These groups deserve an even greater share of our focus and attention to right historical wrongs and reduce barriers for people who are very much in need.

What does this mean for marketers?

The real challenge for marketers is to use everything at our disposal to battle constriction and widen the aperture of choice and access. We can focus on health insurance literacy – not just health literacy – and run campaigns designed to help consumers better understand their choices. We can use digital tools to make scheduling easier, make choices clearer, and make financial impacts easier to understand. Marketers can demystify healthcare and provide tools and content to empower consumers, battling the misinformation and barriers deliberately erected by many health plans, as well as historical inequities.

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