Up-selling Healthcare
Anecdotes from some of my interactions in 2019
TLDR; Social authority of doctors, information asymmetry, conflicting interests of patients and doctors, and blurred lines between health and wellness open the pathway to unethical upselling of healthcare services and products. It’s worth scrutinizing business and tech-centric approaches towards healthcare and wellbeing on these lines.
In March 2019, I was in Delhi. I had fractured my leg earlier and had to call a physiotherapist home to visit me twice a week. One evening as the physiotherapist was setting up his equipment, he got on a call with his colleague and a doctor. From what I could hear, it seemed like the patient they were discussing was a kid who had already taken some sessions with the physiotherapist’s colleague. The patient hadn’t recovered completely and the 3 people on the call were discussing how to get the patient to purchase more sessions.
Here’s what my physiotherapist recommended to his colleague. First, he said tell the patient’s parents that the condition seems serious since the patient hasn’t recovered and that they should consult the doctor again. Next, he told the doctor “Sir aap fir thoda doctor wala tight language use kariye in patient ke saath” (which translates from Hindi to “Sir, please use some scary medical jargon with the patient when they consult you”). The doctor then asked the background of the patients. The colleague said that both parents are working and the family lives in a rented flat. The father works night shifts while the mother works day shifts. Based on these details the doctor suggested the higher value therapy package that he would recommend and suggested that the therapist state a higher rate and then offer a discount by citing the relationship with the doctor and because he wants the kid to not have to suffer. The call ended and my own physiotherapist started administering therapy — the need for which I too began questioning.
Clearly the use of the doctor’s authority and the information asymmetry were at play and the parents probably purchased the therapy package that was upsold to them. To some extent, the therapists must have felt the need to push more therapy because the patient clearly needed it but at the same time people tend to cut corners and not take the full treatment if they feel they are getting better. On the other hand, information asymmetry can make it easy for care providers to upsell unnecessary treatments.
After this incident, I stopped getting my therapy from this physiotherapist and started visiting another nearby center. The first three sessions were fine, but on the fourth session the therapist started trying to contort my legs in different directions and started saying “Oh no this is bad, your hamstrings are extremely weak and tight. Your problems are not limited to the fracture but run deeper given your sedentary lifestyle and you need to work with me to rectify this immediately or you’ll face a lot of issues going ahead.”
In spite of the fresh memory of fear-based upselling, I was fairly concerned. Luckily, I was going to my hometown in Mysore and decided to put off any expenses until I could get an opinion from our family doctor who had known me since I was a kid. As soon as he saw me and ran his diagnosis, he said all was fine. If I really cared for more flexibility I could do yoga etc. he said. But there was no real medical concern.
The blurred lines between health and wellness were used in an attempt to upsell services by this second physiotherapist. These anecdotes have taught me that incentives in healthcare can be misaligned and it is worth considering how information asymmetry can end up being misused to peddle unnecessary products and services.
