A Practical Roadmap for the Perilous Journey from a Culture of Entitlement to a Culture of Accountability (Reform‪)‬

In a culture of entitlement there is the belief that one deserves certain rewards, rights, and privileges based on tradition or past achievements. In contrast, in a culture of accountability rewards, rights, and privileges are only earned based on the merits of one's current behaviors and actions and the measurable results they produce. The transition from a culture of entitlement to a culture of accountability is a perilous journey because rights and privileges are no longer automatic, and the "entitled party" usually feels disappointed, angry, or mistreated. A culture of entitlement is deeply embedded in the US healthcare system: patients believe they are entitled to state-of-the-art care regardless of their unhealthy lifestyles; physicians believe they are entitled to a high degree of clinical autonomy and historical levels of compensation regardless of the outcomes of their patients; hospitals believe they are entitled to be reimbursed at the highest rates in the world regardless of their inefficiencies or the results they produce; and suppliers (e.g., insurance and pharmaceutical companies) believe they are entitled to high margins regardless of the relative value they provide to the system.