It is widely accepted that central authorities in welfare state should redistribute a portion of individual wealths to common wealth that finances medical services for people that are not able to pay for them.

There are two shifts that happen in such welfare redistribution.

Redistribution

Should the redistributed wealth (money) get directly into the hands of underprivileged, who would then decide with which health institution (service provider) to exchange their value (money), patients would still act as customers and not stakeholders. Underprivileged and thus subsidized health service users would still act as traditional customers using money, albeit this money would originate from public redistribution. The first shift is thus the redistribution only.

Wrong beneficiary 

The situation drastically changes when the second shift enters, this one being the transfer of “common wealth” to another public authority and not to patients. With that apparently insignificant shift the necessary balance between customer and service provider is seriously damaged. In this case, where redistribution is followed by taking the patient out of equation, the exchange of values occurs between a public authority that received the money and service provider. In such situation patient is no longer the customer. Public authority suddenly appears in the position of customer.

Since each service provider focuses on his customer, it is natural that doctor as service provider cares more about Public authority with whom he exchanges values than about his patient. His oath demands to be loyal to a patient but his wallet ties him to Public authority.

What happens in such situation is that service users (patients) shift their position within brand formula of such service provider from customers to stakeholders. They cannot be seen as customers since they have nothing to exchange for service offered by a doctor. They become stakeholders that benefit from the mission part of service provider brand. It is a mission of public authority to make earth a better place for living, but they do their business through business model tied to vision where doctors come to play the role. Patients as beneficiaries of a mission are fed by externalia of exchange and not by exchange of values themselves. 

It is thus not a mistake but a necessity that a patient in such a system does not feel like a respected customer. He is not a customer, he is only a user. And it would be an anomaly for such service providers (doctors) to see their patients as customers! 

Patients having a stakeholder status in such situation represent a not-really necessary cost. It is not worth to invest in mission/stakeholders as much as in vision/customers. To save on users that are not customers is a part of necessary business logic for any enterprise, health institutions being no exemption. 

There is thus no chance that patients in a welfare state that redistributes common wealth to Public authorities and not directly to patients, would be treated as valued customers.