A blog covering the health/care ecosystem and people.

Every company is a tech company, strategy consultants asserted over the past decade. The coronavirus pandemic has revealed that every company is a health and wellness company now, at least in the eyes of consumers around the world. In The Wellness Gap, the health and wellness team at Ogilvy explores the mindsets of consumers in 14 countries to learn peoples’ perspectives on wellness brands and how COVID-19 has impacted consumers’ priorities. A total of 7,000 interviews were conducted in April 2020, in Asia, Europe, Latin America, and North America — including 500 interviews in the U.S. The first chart illustrates

2020 will be remembered for disruption and dislocation on many fronts; among the major blips in the year will be it remembered as the largest funding year for digital health recorded, according to Rock Health’s report on the 3Q2020 digital health funding. This funding record (“already” before year-end, tallied by the third quarter as Rock Health notes) was driven by “mega”-deals accelerated during the public health crisis of COVID-19. In the third quarter of 2020, some $4 billion was invested in U.S. based digital health start-ups adding up $9.4 billion in 2020….so far. This is $1.2 billion more than two

In May 2020, the Oxford English Dictionary (OED) re-visited the acronym, “PPE.” As OED evolves the definition of PPE, the wordsmiths could borrow from OSHA’s website, noting that PPE, “is equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses. These injuries and illnesses may result from contact with chemical, radiological, physical, electrical, mechanical, or other workplace hazards. Personal protective equipment may include items such as gloves, safety glasses and shoes, earplugs or muffs, hard hats, respirators, or coveralls, vests and full body suits.” Perhaps Definition 3 in the OED could be updated by a blog

On February 4th, 2020, in a hospital in northern California, the first known inpatient diagnosed with COVID-19 died. On March 11th, the World Health Organization called the growing prevalence of the coronavirus a “pandemic.” On May 25th, George Floyd, a 46-year-old Black man, died at the hands of police in Minneapolis. This summer, the Dixie Chicks dropped the “Dixie” from their name, and NASCAR cancelled the confederate flag from their tracks. Today, nearly 200,000 Americans have died due to the novel coronavirus. My new book, Health Citizenship: How a virus opened hearts and minds, launched this week. In it, I

In the U.S., symptoms of depression were three-times greater in April 2020 in the COVID-19 pandemic than in 2017-2018. And rates for depression were even higher among women versus men, along with people earning lower incomes, losing jobs, and having fewer “social resources” — that is, at greater risk of isolation and loneliness. America’s health system should be prepared to deal with a “probable increase” in mental illness after the pandemic, researchers recommend in Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic in JAMA Network Open. A multidisciplinary team knowledgeable in medicine, epidemiology, public health,

The coronavirus pandemic added a new concept to our collective, popular lexicon: “social distancing” and “physical distancing.” This was one pillar for the public health prescription we were given to help mitigate the spread of a very tricky, contagious virus. A major negative impact of our sheltering in place, working from home, and staying indoors has been a sort of clearing out of cities where people congregate for work, for culture, for entertainment, for education, for travel and tourism…for living out our full and interesting lives and livelihoods. Intel gave Harbor Research a mandate to “re-imagine life in a post-pandemic

The pandemic has become a sort of forcing function on all aspects of daily living, include health care. Deloitte’s latest wave of health care consumer market research updates the COVID-19 impacts on the U.S. health care landscape and asks the question in the study report’s title: “Are consumers already living the future of health?” For the general survey of U.S. Health Consumers, Deloitte polled 4,522 U.S. adults 18 and older online in February and March 2020. Deloitte conducted an additional 1,510 interviews with consumers in April to gauge peoples’ perspectives on the pandemic, health and well-being. In the Great Lockdown

While I’m on holiday this week, restoring and re-setting, I’ve been sharing pages from my ABCovid-19 Journal with readers of Health Populi. I created this journal during the early phase of the pandemic in the U.S., as a form of art therapy, creative outlet, and learning. Today is Day 4 of sharing: we consider the letters “P” through “T,” and what I saw in the early coronavirus era. P is for pandemic This “P” was self-evidence in our collective early COVID-19 lexicon. The “P” word was uttered by the Secretary General of the World Health Organization on March 11, confirming

Welcome to Day 2 of my #COVID19 holiday break, welcome to my ABCovid Journal, letters “F” through “J. If you hadn’t tuned into the Health Populi blog yesterday, 10th August 2020, you missed the first five letters of my Age of Corona alphabet, curated in my art journal created in the early weeks of the pandemic. Click the link to back-track and catch up with us… I should explain why I’m sharing this project in the Health Populi blog this week. Last month, long-time colleague and friend Colin Hung interviewed me on the #HITMC broadcast to discuss a lovely recognition

The coronavirus pandemic accelerated many trends and new workflows for patients and consumers, and health care providers, too. The convergence of basic needs like hygiene and safety, financial and health security, and living-working-learning-and-cooking-at-home has turbocharged a migration of more acute care delivered at home. I explore this growing concept in my latest essay on Medecision’s Liberation blog, How the Pandemic Is Accelerating the Hospital-At-Home Concept. The key points are that: Hospital-at-home services (H-a-H) combine home visits with virtual care and remote monitoring Think: advanced home care, enabled through virtual health technologies and wrap-around services both clinical and scaled social determinants

Patients embraced virtual care and communications at very high rates in the first months of the pandemic, and want to continue to use telehealth platforms after the pandemic ends. The new era of virtual care has begun and is here to stay, Accenture expects in its latest look at How COVID-19 will permanently alter patient behavior, a patient survey conducted in May 2020. Accenture polled 2,700 patients around the world, 450 participants each from China, France, Germany, Japan, the U.K., and the U.S. Patients represented one of three conditions, with one-third each managing cardiovascular, immunology/rheumatology, and oncology. Topline, consumers “faced

The core business of hospitals is patient care, often baked with teaching and research. But wait — there’s more, asserts the Lown Institute in their approach to ranking America’s Best Hospitals in 2020. The Institute’s methodology for assessing what’s “best” addresses ten pillars. Several of these are the “stick-to-the-knitting” components of the Webster Dictionary definition of hospital work: patient outcomes, clinical outcomes, avoiding overuse, patient safety, and a recent focus, patient satisfaction. Community benefit has been part of a hospital’s life, especially in the not-for-profit world where hospitals must demonstrate goodwill generated for and provided in the neighborhoods in which

Whether healthcare spending in 2021 increases by double-digits or falls by one-third directly depends on how the coronavirus pandemic will play out over the rest of 2020, based on PwC’s annual report on medical cost trends for 2021. The three cost scenarios are based on assumptions shown in the fine print on the first chart: The medium scenario, a sort of “return to normal” where medical trend could stay even at 6.0%, equal to the 2020 trend. This assumes that healthcare spending recovers by October 2020 as patients return to hospitals and doctors’ offices for regular care patterns. In 2021,

You’ve heard the one about three characters walking into a bar. A new collaboration between United Airlines, Cleveland Clinic and Clorox reminded me of that scenario, and that in the age of the coronavirus pandemic, collaboration can bolster our health. In the era of COVID-19, people — consumers. patients managing chronic conditions, and caregivers (whether for younger or older loved ones) — are concerned about contracting the virus. In U.S. states where governors mandated shelter-at-home for much of the first half of 2020, millions of people have become conditioned to physically distance, wear face coverings, and #StayHome. In particular, workers

What a difference 90 days makes. I was scheduled to meet with Roy Jakobs, Chief Business Leader of Connected Care at Philips, at HIMSS in Orlando on 9th March 2020. I’d interviewed Roy at CES 2020 in Las Vegas in January to catch up on consumer health developments, and the March meeting was going to cover Philips’ innovations on the hospital and acute care side of the business, as well as to learn more about Roy’s new role as head of Connected Care. HIMSS cancelled the conference just days before it was to commence….due to the great disruption of COVID-19.

As we wrestle with just “what” health care will look like “after COVID,” there’s one certainty that we can embrace in our health planning and forecasting efforts: that’s the persistence of telehealth and virtual care into health care work- and life-flows, for clinicians and consumers alike and aligned. There’s been a flurry of research into this question since the hockey-stick growth of telemedicine visits were evident in March 2020, just days after the World Health Organization uttered the “P-word:” pandemic. Three recent reports (among many others!) bolster the business and clinical cases for telehealth in America in terms of: A

This week, Hims & Hers announced they would be a new consumer-facing retail channel for coronavirus testing. You can order the test here for $150 cash out-of-pocket. The packaging states that this is a saliva test, “to detect current presence of COVID-19.” The fine print on the Hims website states: This test has been authorized by the FDA under an Emergency Use Authorization for use by authorized laboratories. This test has not been FDA cleared or approved. This test has been authorized only for the detection of nucleic acid from SARS-CoV-2, not for any other viruses or pathogens. This test

The spread of infectious disease is the new terrorism in the eyes of Americans. The most significant major threat to the U.S. is infectious disease, four in five Americans said in March 2020, closely followed by terrorism (in general), the spread of nuclear weapons, and cyberattacks from other countries. For the study, the Pew Research Center commissioned a telephone survey conducted among 1,000 U.S. adults in March 2020. Large majorities of people are also highly concerned about China’s growing power and influence, global climate change, Russia’s power and influence, the condition of the global economy, and global poverty. The percent

As the coronavirus pandemic’s curve of infected Americans ratchets up in the U.S., people are seeking comfort from listening to Dolly Parton’s bedtime stories, crushing on Dr. Anthony Fauci’s science-wrapped-with-empathy, and streaming the Tiger King on Netflix. These and other self-care tactics are taking hold in the U.S. as most people are “social distancing” or sheltering in place, based on numbers from the early April 2020 Kaiser Family Foundation health tracking poll on the impact of the coronavirus on American life. While the collective practice of #StayHome to #FlattenTheCurve is the best-practice advice from the science leaders at CDC, the NIAID

As people conform to the #StayHome lifestyle to #FlattenTheCurve of the coronavirus pandemic, technology is transforming peoples’ home lives for working, playing, and socializing. The Consumer Technology Association has conducted the COVID-19 Impact Study assessing the use of technology at home, exploring U.S. households’ changing behaviors for consuming content, stocking the pantry, engaging with social media, and using online health and fitness tools. This research surveyed 1,004 U.S. adults 18 and over in March 2020 — early in the U.S. pandemic’s national “curve.” U.S. consumers’ top five technology purchases in mid-March 2020 were for smartphones, laptop computers, TVs, and headphones/earbuds.

U.S. health care spending will grow to 20% of the national economy by 2028, forecasted in projections pre-published in the April 2020 issue of Health Affairs, National Health Expenditure (NHE) Projections. 2019-28: Expected Rebound in Prices Drives Rising Spending Growth. NHE will grow 5.4% in the decade, the model expects. But…what a difference a pandemic could make on this forecast. This year, NHE will be $3.8 trillion, growing to $6.2 trillion in 2028. Hospital care spending, the largest single component in national health spending, is estimated at $1.3 trillion in 2020. These projections are based on “current law,” the team

More Democrats would want to get tested for the coronavirus (C19) than would Republicans. And, more women than men believe that a vaccine to address the COVID-19 pandemic believe that treatment would be offered at no-or-low-cost under a Democratic president versus President Trump. These are two key insights gleaned from a look into U.S. adults’ perspectives on the C19 virus in the second week of March 2020. What Are Americans’ Views on the Coronavirus Pandemic? asks and answers an NBC News/Commonwealth Fund Health Care Poll published on 20th March 2020. NBC News and the Commonwealth Fund polled 1,006 people 18

Will the coronavirus inspire greater adoption of telehealth in the U.S.? Let’s travel to Shanghai, China where, “the covid-19 epidemic has brought millions of new patients online. They are likely to stay there,” asserts “The smartphone will see you now,” an article in the March 7th 2020 issue of The Economist. The article returns to the advent of the SARS epidemic in China in 2003, which ushered in a series of events: people stayed home, and Chinese social media and e-commerce proliferated. The coronavirus spawned another kind of gift to China and the nation’s health citizens: telemedicine, the essay explains. A

Millions of dollars and developers’ time have been invested in conceiving and making digital health tools. Yet with that bullish supply side of digital health,  there was a marked decline in peoples’ use of them in the past two years, found by Accenture in their latest health consumer survey, Digital is Transforming Health, So Why is Consumer Adoption Stalling? Use of mobile apps to track personal health activity fell from nearly 1 in 2 consumers to 1 in 3. Use of wearable tech nearly halved, from 33% to 18%, between 2018 and 2020. Some, but not necessarily a majority, of

The Consumer Technology Association (CTA), collaborating with industry stakeholders, has ushered in a standard for artificial intelligence in health care.   CTA is the membership organization for companies that innovate, manufacture and market consumer-facing tech like big-screen TVs, slick new autos, video games and voice assistants. So what’s an organization like CTA doing with AI and health care? Let me connect the dots. Check out this graphic taken from my book, HealthConsuming: From Health Consumer to Health Citizen. This shows the ten categories of tech I revisit each year at CES, CTA’s annual mega-conference of new-new things in consumer electronics

There are 1,844 rural hospitals operating in the U.S. That number is down by 19 in the 2019 calendar year, the worst year of rural hospital closings seen in the past decade. That hockey-stick growth of closures is shown in the first chart, where 34 rural hospitals shut down in the past 2 years. Rural U.S. hospitals are in poor fiscal health. “The accelerated rate at which rural hospitals are closing continues to unsettle the rural healthcare community and demands a more nuanced investigation into rural hospital performance,” threatening the stability of the rural health safety net, according to the

Americans who have commercial health insurance (say, through an employer or union) are rarely thought to face barriers to receiving health care — in particular, primary care, that front line provider and on-ramp to the health care system. But in a new study published in the Annals of Internal Medicine, commercially-insured adults were found to have visited primary care providers (PCPs) less often, and 1 in 2 had no PCP visits in one year. In Declining Use of Primary Care Among Commercially Insured Adults in the United States, 2008-2016, the researchers analyzed data from a national sample of adult health

Economic development has historically built trust among nations’ citizens. But in developed, wealthier parts of the world, like the U.S., “a record number of countries are experiencing an all-time high ‘mass-class’ trust divide,” according to the 2020 Edelman Trust Barometer. For 20 years, Edelman has released its annual Trust Barometer every year at the World Economic Forum in Davos, recognizing the importance of trust in the global economy and society. Last year, it was the employer who was the most-trusted touch-point in citizens’ lives the world over, I discussed in Health Populi one year ago. This year, even our employers can’t

Physicians are evolving as digital doctors, embracing the growing role of data generated in electronic health records as well as through their patients using wearable technologies and mobile health apps downloaded in ubiquitous smartphones, described in The Rise of the Data-Driven Physician, a 2020 Health Trends Report from Stanford Medicine Stanford Medicine interviewed 523 physicians and 210 medical students and residents in September and October 2019 to assess clinicians’ perspectives on digital health topics for this study. The study title citing the “data-driven physician” is based on the key survey finding that doctors are preparing to embrace data, from both traditional

The digital health presence at CES 2020 is the fastest-growing segment of consumer technologies at the Show this year, increasing by 25% over 2019. Heart-focused technologies are a big part of that growth story. In fact, in our search for devices and tools underpinned with clinical proof, evidence is growing for consumer-facing technology for heart-health, demonstrated by this year’s CES. Wrist-worn devices, digital therapeutics, patient engagement platforms, pharma and health plans converged at this year’s CES, with the professional association “blessing” of the American College of Cardiology who granted a continuing medical education credit for physicians attending a one-day “disruptive

In CTA’s 2020 Consumer Tech Forecast launched yesterday at Media Day 1 at CES, Steve Koenig VP of Research, said that, “digital health is an ecosystem of ecosystems.” Health, medical and wellness trends featured large in the forecast, which brought together key trends for 5G, robotics, voice tech, AR/VR/XR, and the next iteration of IoT — which Steve said will still be called “IoT,” but in this phase will morph into the “Intelligence of Things.” That speaks to Steve’s phrase, “ecosystem of ecosystems,” because that’s not just “digital” health — that’s now the true nature of health/care, and what is

Across the U.S., the health/care ecosystem warmly embraced social determinants of health as a concept in 2019. A few of the mainstreaming-of-SDoH signposts in 2019 were: Cigna studying and focusing in on loneliness as a health and wellness risk factor Humana’s Bold Goal initiative targeting Medicare Advantage enrollees CVS building out an SDOH platform, collaborating with Unite US for the effort UPMC launching a social impact program focusing on SDoH, among other projects investing in social factors that bolster public health. As I pointed out in my 2020 Health Populi trendcast, the private sector is taking on more public health

There’s something like cognitive dissonance as I prepare my 2020 Health Populi TrendCast of what to expect in the health/care ecosystem in the new year. One of my key pillars for health-making is food-as-medicine, and that opportunity in this moment resonates in this holiday season with Dickens’ “Best of Times, Worst of Times” context-setting that kicks off Great Expectations. In the “best of times” part of the food+health equation, we recognize the growing role of grocery stores, food-tech and food manufacturers in the health/care landscape. A current example comes from Kroger, partnering with Ascension’s health system in Tennessee, enhancing the organization’s

Two separate and new OECD reports, updating health and the global economic outlook, raise two issues that are inter-related: that gains in longevity are stalling, with chronic illnesses and mental ill health affecting more people; and, as wealth grows more concentrated among the wealthy, the economic outlook around most of the world is also slowing. First, we’ll mine the Health at a Glance 2019 annual report covering data on population health, health system performance, and medical spending across OECD countries. The first chart arrays the x-y data points of life expectancy versus health spending for each of the OECD countries

As technology continues to re-shape consumers’ experiences and expectations with health/care, retail, travel and work, peoples’ concerns about data privacy are also growing as observed by a 2020 consumer trends forecast from GlobalWebIndex, Connecting the dots. First, some overall context to the study. GlobalWebIndex “connects the dots” of consumers trends in 2020 including the topics shown in the first graphic including commerce and retail, gaming, travel, human touch, nostalgia, privacy and digital health — the first of these trends discussed in the report. Note that the data discussed in this post include responses from consumers residing in both the U.S.

“Google’s ‘Project Nightingale’ Gathers Personal Health Data on Millions of Americans,” the Wall Street Journal reported in today’s paper and on the WSJ.com website. The story started with the scenario that, “Search giant is amassing health records from Ascension facilities in 21 states; patients not yet informed.” Here’s Ascension’s press release on the collaboration, described in the title as “healthcare transformation.” Note: this release was written after the Wall Street Journal published this story. And, according to the WSJ reporting, “Neither patients nor doctors have been notified. At least 150 Google employees already have access to much of the data

On the demand side of U.S. health care economics, patients are now payors as health consumers with more financial skin in paying medical bills. As consumers, people have great expectations from the organizations on the supply side of health care — providers (hospitals and doctors), health insurance plans, pharma and medical device companies. But as payors, health consumers face challenges in getting care, so great expectations are met with frustration and eroding trust with the system, according to the latest Connected Healthcare Consumer report from Salesforce published today as the company announced expansion of their health cloud capabilities. This is

Patients searching online for health information and health care provider reviews is mainstream in 2019.  Digital health tracking is now adopted by 4 in 10 U.S. consumers. Rock Health’s Digital Health Consumer Adoption Report for 2019 was developed in collaboration with the Stanford Medicine Center for Digital Health. Rock Health’s research has tracked peoples’ use of telemedicine, wearable technology, digital health tracking, and online health information since 2015, and the results this round show relative flattening of adoption across these various tools. Rock Health’s top-line findings were that: Patient-generated health data creates opportunity, and potential challenges Online health information is

Rising health care costs continue to concern most Americans, with one in two people believing they’re one sickness away from getting into financial trouble, according to the 2019 Survey of America’s Patients conducted for The Physicians Foundation. In addition to paying for “my” medical bills, most people in the U.S. also say that income inequality and inadequate social services significantly contribute to high medical spending for every health citizen in the nation. The Physicians Foundation conducts this study into Americans’ views on the U.S. health care system every other year. This year’s poll was conducted in September 2019 and included input

The market for caregiving is growing and the business community has, finally, begun to pay attention. The Washington Post referred to this market as a “gold rush” to design smart shoes, custom razors and technology for the “over-65 crowd.” Caregiving in the U.S., the seminal report from AARP, estimated that 43,5 million adults in the U.S. had provided unpaid care to an adult or child in the past year, about one in five people being caregivers. Over half of caregivers are women, and are about 49 years of age on average. Caregivers spent over 24 hours a week providing care go

The three winners of the 2019 Nobel Prize for Economics — Banerjee and Duflo (both of MIT) and Kremer (working at Harvard) — were recognized for their work on alleviating global poverty.” “Over 700 million people still subsist on extremely low incomes. Every year, five million children still die before their fifth birthday, often from diseases that could be prevented or cured with relatively cheap and simple treatments,” The Nobel Prize website notes. To respond to this audaciously huge challenge, Banerjee, Duflo and Kremer asked quite specific, granular questions that have since shaped the field of development economics — now

SelfCare is health/care, particularly as patients, everyday people, take on greater responsibility for clinical decisions and paying for medical services. We’re convening today through Sunday in Indianapolis with GMDC, the Global Market Development Center and Retail Tomorrow to brainstorm the current and future prospects for SelfCare, health and wellness in the hands, hearts, and homes of consumers. To bolster the message and engage with industry stakeholders, GMDC collaborated with the Hamacher Resource Group to develop a SelfCare Roadmap, an interactive tool that provides insights into twelve conditions where consumers typically looking to DIY their health using over-the-counter medicines, supplies and

“We knew millions of people weren’t getting the care they needed — they were either too embarrassed to seek help or felt stuck in a system that was confusing and intimidating. Digital health has the potential to radically change the way people approach their wellness and, since launching in 2017, we’ve outpaced even our own expectations, delivering more than 1 million Hims & Hers products to our customers. In collaboration with highly-qualified doctors and healthcare providers, we’ve built a digital health platform that is changing the way people talk about and receive the care they need.” That’s  a verbatim paragraph

Turning 13, “we’re an unruly teenager on our hands now,” Matthew Holt invoked the start of the annual Health 2.0 Conference, convening this week in Santa Clara for its 13th year in existence. Started with Co-Founder Indu Subaiya, Health 2.0 was conceived as a “movement,” Matthew explained. “When (we were) younger, we broke some things.” Indu continued on that riff, “we’re breaking barriers now (that) we are older, and it’s time to raise the bar.” In the yin-and-yang riffing style that is the brand of this duo, Matthew continued in that vein of “breaking things,” invoking a metaphor of storming

“Every company is a tech company,” Christopher Mimms asserted in the Wall Street Journal in December 2018. Connectivity, artificial intelligence, and automation are now competencies every company must master, Mimms explains. This ethos underpins Humana’s decision to join CTA, the Consumer Technology Association which hosts CES every January in Las Vegas. If you read this blog, you know one of the fastest-growing “aisles” at the annual conference is digital health. Humana joined up with CTA’s Health and Fitness Technology Division this month. Last year, Humana hired Heather Cox in the new post of Chief Digital Health and Analytics Officer, reporting directly

As patients continue to morph into health care payers, they’re increasingly expecting value-for-money, transparency, and customer experiences that show respect, bolster trust, and deliver quality services. Is that so much to ask from health care providers? Sure is, as it turns out, based on this year’s annual report from Kaufman Hall, the 2019 State of Consumerism in Healthcare: The Bar is Rising. For several years, Kaufman Hall have developed an Index of healthcare consumerism based on several pillars that, together, gauge health care providers’ performance on consumer health engagement. Providers fall into one of four tiers, ranging from Tier 1

One in three Americans does not have a broadband connection, according to a new report from the NPD Group. This means that about 100 million people in the U.S. can’t benefit from telehealth and other digital health connections that can bolster self-care, home care, and lower cost care. Most of these folks in the broadband-digital divide live in rural America/ “The so-called digital divide, between those that can or cannot make the best use of the Internet, can be clearly felt in rural markets where the lack of broadband impacts everything from entertainment to the educational system,” Eddie Hold, President

There are about 55 million patient records held by the United Kingdom’s National Health Service (NHS). Their monetary value to private sector companies would be £5 billion and nearly that much in patient benefits. Add in value for patient outcomes, and the total approaches £10 billion. In today’s UK:US currency exchange rate, 10 billion British pound sterling is worth roughly $12 billion. Realising the Value of Healthcare Data from EY explores how patient data can, in the words of the report, “unlock significant operational savings, enhanced patient outcomes, and wider economic benefits” for the NHS and patients through using artificial

Today is July 15, and my email in-box is flooded with all flavors of Amazon Prime’d stories in newsletters and product info from ecommerce sites — even those outside of Amazon from beauty retailers, electronics channels, and grocery stores. So I ask on what will probably be among the top ecommerce revenue generating days of all time: “What could health care look like when Amazon Prime’d?” I ask and answer this in my book, HealthConsuming, as chapter 3. For context, this chapter follows two that explain how patients in the U.S. have been morphing into health consumers based on how health