If you went to a hospital or a clinic and you weren't satisfied with the quality of care you received, should you get your money back? Should somebody give you a rebate or some kind of a cash discount if you were unhappy? The Geisinger Health System, a very large healthcare program based in Pennsylvania, has decided that it is going to offer money-back guarantees when patients are unhappy. Don't get me wrong; they're not necessarily going to say, "The surgery didn't come out the way you wanted, so here's $500 back." This is a more about the quality of the services provided. "Were you waiting a long time?" "Were you dissatisfied with the food?" "Did you believe you didn't receive good communication?" "Were you unhappy because you didn't know where you should go or were misdirected?" Some people are going to say that offering money-back guarantees is just one more step toward turning medicine completely into a business. Are we really going to do the same thing that Starbucks or other restaurants do and say, "If you don't like it, we'll make it again or give you your money back"? I'm afraid that we're already pretty far down the road of the business of medicine, and therefore these money-back guarantees don't bother me especially much. For people who are dissatisfied with the quality of the food they receive or with waiting too long, it does make some sense to start to say, we'll give you something, like a rebate; a voucher for something else; or a free gift, such as a newspaper or access to cable television, while you're staying with us. The quality of care that people receive obviously can and does shape their ability to get better and their willingness to trust the system. I admire the Geisinger Health System's willingness to announce that if you don't like the way we're treating you, then we're going to try and make it up to you or make good on this. It's disruptive, but there are some things that deserve some disruption in healthcare, and this area of consumer satisfaction might well be one of them. My only reservation is whether patients start to think more about such matters as how long they waited to get their car back from the valet or how long they had to sit in the waiting room, rather than asking hard questions about the actual care they received, by diverting them more to the frosting and away from the cake of whether we did a good job of providing care. However, putting that aside—and it's not a small matter to put aside—part of healthcare is making sure the experience is satisfactory to the customer. And if money-back guarantees can make that experience better, then I guess I'm for it.
