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January 27, 1999

Words in "In A Word"

Author Affiliations

Margaret A.Winker, MDIndividualAuthorPhil B.FontanarosaMD, Senior EditorsIndividualAuthor

JAMA. 1999;281(4):322-323. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-4-jbk0127

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.

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