How can we make healthcare more productive? was the topic of a LinkedIn discussion started by Joe Flower, author of the book, “Healthcare Beyond Reform: Doing It Right For Half The Cost.” It generated some lively discussion and prompted me to respond as well.
My response to How can we make healthcare more productive?
CHANGE THE TERMINOLOGY – America has excellent MEDICAL Care, if you can afford it, but we have a horrible HEALTH Care system and desperately need to focus more on health & wellness. We spend twice as much as other nations but still live sicker and die younger, per the WHO. That means we “should” be able to cut costs in half at least while simultaneously improving care quality, patient satisfaction, worker productivity, and GDP.
START WITH EDUCATION – We now teach new doctors how to diagnose and treat illness & injury, not how to prevent it, and that feeds into our fee-for-service SICK Care system that profits from doing more – more tests, more procedures, more drugs. Little time is spent teaching medical students about public health and the pillars of health (exercise, nutrition & sleep), because that doesn’t fit into our for-profit business models.
CHANGE THE INCENTIVES – You can’t change of behavior without understanding and changing the incentives. When the incentives contradict the marching orders, human nature may work against strategy. Take EMR as an example. Hospital A has a financial disincentive to share medical records with Hospital B, because they fear losing the patient and their revenue. Likewise, Hospital B has no incentive to get records from Hospital A, because it could eliminate the need to reschedule tests, and the revenue from them.
BLEND THE INCENTIVES – Stakeholders often measure success differently and thus have conflicting incentives, so it’s important to understand those conflicts. Consider the difference between the Private & Public sector organizations as an example. The private sector measures success in business terms like profit, ROI, and payback period, so they see investments through a relatively short-term lens. The profit motive, however, provides a strong incentive to innovate, and it rewards risk-takers. Contrast that with public sector organizations that are able to invest over much longer timeframes because they rely on public funding and seek benefits for society rather than shareholders. Their measurements include things like average lifespan, quality of life, graduation rates, GDP, etc. Public-private partnerships can blend the best attributes of these different incentives.
UNIVERSAL HEALTHCARE – We’re the only major nation without it, but if we had something like Medicare for All, then politicians would have different incentives. Rather than focus on how to cut medical care benefits, there would be pressure to save money and improve corporate performance with policies designed to keep the population well and productive.
REWARD INNOVATION – Capitalism and patent protection rewards innovation when there’s competition on a level playing field, but monopoly power can stifle it. That’s especially true when extreme wealth is concentrated in the hands of a few who are then able to use their financial power to get political power and distort the rules & playing field in their favor. Note that the Medical Industrial Complex (drug companies, insurers, hospitals, testing companies & equipment providers) currently spends twice as much on lobbying as the military industrial complex, and Citizens United only made the corrupting influence of big money in politics worse, as we’re already seeing in this election cycle.
REFORM POLITICS – At the core of fixing healthcare is fixing politics. The benefits of doing that will flow down to all sorts of other factors affecting the cost & effectiveness of health care, including poverty, food supply, environmental contamination, education, infrastructure, etc.
SHAME THE POLITICIANS – Satire can be a powerful weapon to motivate citizens and encourage political activism. This video makes fun of the health care industry by looking at what the airline industry would be like if it worked the same way. (http://www.mhealthtalk.com/if-air-travel-worked-like-health-care/). Other related videos on this site include:
- http://www.mhealthtalk.com/escape-fire-rescuing-healthcare/ http://www.mhealthtalk.com/corporate-behavior-and-rising-health-care-costs/
- http://www.mhealthtalk.com/the-waiting-room/ (about poverty)
- https://www.youtube.com/watch?v=B8wkeNDAGyM (Choosing to Die)
RELATED ARTICLES – I often write or post articles at Modern Health Talk about health reform topics, and for those interested, here are some examples:
- http://www.mhealthtalk.com/2013/02/why-high-medical-bills-are-killing-us/ (summary of article by Steven Brill, TIME Magazine)
- http://www.mhealthtalk.com/2011/12/innovators-prescription/ (summary of book by Harvard Business School’s Clayton M. Christensen)
- http://www.mhealthtalk.com/hybrid-model/ (a public/private model of health care)
- http://www.mhealthtalk.com/2014/05/future-of-medicine-not-medicine/ (about nutrition and wellness)
- http://www.mhealthtalk.com/medical-sensationalism-for-profit/ (satire of Dr. Oz)
Joe Flower introduces his book
Joe says, “There are only five things we need to do. We need all five.” But he doesn’t say what they are and instead wants you to buy his book. I’m not a fan of that approach, and as you can tell from browsing Modern Health Talk, the perspectives I offer are shared for free. I’ve maintained this website myself for more than 3 years and have accumulated over 600 articles and 12,000 healthcare infographics. So if you’re in Austin and want a speaker on this topic, call me instead.