by Frank Riessman

Overlooked in discussions of managed care is the importance of the active consumer in cutting costs and improving health care. A whole body of evidence demonstrates ways in which active consumers may expand services and, ultimately, add significantly to the productivity of the health-care system, while at the same time contributing to their own health. At the simplest level, consider how diabetics monitor their own blood sugar.

At another level, participation in self-help support groups has been shown to have considerable impact on a variety of disorders. Dr. Dean Ornish, a California specialist in coronary heart disease, found that patients who participated in a support group in his treatment program had the following outcomes: chest pains diminished or disappeared, severe blockages in coronary arteries reversed, and patients became more energetic. He notes that, “At first I viewed our support groups simply as a way to motivate patients to stay on the other aspects of the program that I considered most important: the diet, exercise, stress management training. Over time I began to realize that the support group itself was one of the most powerful interventions.”

Results of a study of psychiatric patients discharged from hospitals who joined support groups showed that they did far better than a control group: functioning better in the community, following their medication regimen more fully and avoiding hospital readmission.

What actually happens in support groups that produces these outcomes? First, members share in a special way because of the similarities of their condition–they understand each other. Being understood is essential. Second, they share information and coping techniques related to their illness or problem. Finally, the general support that emerges in practically all mutual-aid groups provides the emotional mind-body link. It’s one of the reasons why people with social support actually survive at higher rates than isolated people.

When you think of the major illnesses today, many are chronic conditions such as heart disease, stroke, diabetes, hypertension, arthritis–conditions that require far less intense medical intervention than do acute illnesses. What they do require is support, concrete help, coping skills and periodic input from a physician.

An active consumer can produce a more cost-effective service where both the consumer and the health-care organization benefit. The consumer gets better health care and is empowered. Management in this context can improve its work by providing added self-help services at minimal cost.

Some dangers and problems may present themselves, however. Self-help groups might be used as a cheap alternative to appropriate professional care, and empowered consumers may demand too much from the point of view of managed care. Although some may prefer the passive patient–who gives no trouble–from a health-promotion perspective, this is more costly.

According to health economist Victor Fuchs, “The greatest potential for improving health is through changes in what people do and do not do for themselves.” That’s why an active consumer is managed care’s best customer.