Costco-Like Health Systems: Has Medicine Outgrown its Limits?

As a resident, I was assisting in the care of a woman in her 60s who was due for a repeat EGD due to her ongoing Barrett’s esophagus.

“Can we help you schedule it here with Dr X?” I asked.
“No thanks, I always get this stuff done down at the Costco hospital. I just like the atmosphere better there.”
“Costco hospital?” I was slightly confused.
“Yeah, the hospital a few miles away with the Costco in the parking lot,” she replied, as if what she was referring to should be clear as day.

There was a very good, very large hospital fairly nearby that did indeed have a Costco in the parking lot. The hospital offered nearly any diagnostic need or treatment you could imagine, so the comparison between the hospital and Costco seemed quite apt.

This stirred my mind. Could this comparison be pertinent to our nation’s healthcare?

Over the past 100 years, healthcare has grown from a very simple, almost cottage industry to a behemoth that is taking over our economy and can reasonably be compared to a superstore where anything you can think of is available, and at very large quantities.

I would argue that a significant contributor to this (though there are certainly many) is the expectation that physicians and healthcare institutions will address many personal and societal issues that influence health and illness.

Please don’t get me wrong. Addressing the social determinants of health is crucial to health, both to acute infectious diseases, as well as chronic illnesses. But often the burden of these solutions falls to physicians (and primarily primary-care physicians) within the context of a 15-minute appointment.

Due to lack of time, lack of training, lack of reimbursement, and the lack of ability to address many of the needed issues, often the patient and physicians are left feeling frustrated and a bit hopeless.

This alone oftentimes leads to a vicious downward spiral in the patient’s medical care, where more diagnostic tests are ordered and more medications are prescribed as Band-Aids to the problem, which then causes worse health outcomes, and further frustration.

This also promotes the current frustration among many physicians of quality metrics based on outcomes, many of which are outside of the physician’s control.

What can we do if our patient with diabetes can only afford food that is high in carbohydrates, has some difficulties with understanding how to address her illness despite our best efforts at education, and has transportation issues with coming to the clinic?

It is an unfortunate reality that our medical organizations are not able to solve these issues, despite the best of intentions.

Some “Costco” healthcare institutions have been built with the idea in mind of filling every diagnostic and treatment need a patient may have.

This has likely contributed to this expectation among society and patients that everything affecting health can be addressed and solved.

Many physicians have also contributed to this mindset with how we approach our patient’s medical needs.

So we need to decide: Do we want healthcare to be a Costco for our country, with the illusion of providing anything and everything you could want, as is oftentimes portrayed? Could we incorporate more multi-disciplinary teamwork, including social workers, Health and Human Services employees, and/or public health officials to attempt to solve some of these problems? Or should we scale back and simply address the issues that we have been taught in our training?

The questions do not have a clear answer, though as our structure has been moving towards increased teamwork to help with some of these concerns, it is important to consider what we want our healthcare system to be.