September 3, 2005
Healthcare is…
It was a difficult choice from yesterday's healthcare happenings. There was the story reporting “miracle mice” that can regenerate amputated limbs and injured organs. I thought that was interesting, but the information hasn't been published yet in real scientific journals. So I passed. But it was only 12 genes!! Let's hope.
Anyway, I thought it was nudged out by the report from the good scientists at the Massachusetts Institute of Technology as reported in the Small Times News who have discovered a polymer coating made of silica nanoparticles that can create surfaces that never fog.
When I read this, I immediately thought of healthcare. Now there is something we could really use.
The principles of The Abramson Family Center For The Future of Health include Transparency, Visibility, Decisioning, and Distributed Healthcare. Transparency means everyone gets access to the same information. Hey, no secrets unless I say it's a secret. And no fog either. I want clarity with my transparency.
Then I got to thinking about what we sometimes refer to as the “healthcare system.” What is it anyway? I challenge everyone reading this to define it. Close your eyes now and visualize. And what is healthcare? If you were giving the proverbial elevator speech, what would you say it is? I mean, talk about fog!!
I'll take a turn at defining healthcare:
Healthcare is a technology-based, information-dependent, personal service .
Sounds good, but what does it mean?
Although the scientific model started gaining prominence in US medicine around the mid-19th century it was not until the early 20th century, spurred by the famous report on medical education by Abraham Flexner, that the model became predominant. And then exclusive. It is powerful. And it showed the way in policy, creating emphasis on technology and treatment intervention in favor of prevention and public health.
In the US at least, and especially in the post-World War II world, massive investments in medical research for the common good were made with tax dollars. This became the “technology basis” for healthcare. It spurred the development of large, if highly regulated industries, including academic medical centers, pharmaceuticals, medical devices, biotechnology, and life sciences. It is our pride and joy. Like Prometheus, we may be chained to a rock with a giant bird eating our liver, but at least we have fire.
Information dependence means that at the point of care delivery, significant information and knowledge must be brought to bear. The traditional way to do this has been to send humans through an ever greater and longer education process. Thus, we traditionally deliver information and knowledge to the bedside and clinic disguised as a human. This worked fine for awhile, when we didn't know too much. But now, the traditional way is severely limited by the size of the human brain.
Our next step was to deliver information and knowledge parsed, dissected, and distributed to an army of specialists. One specialist for each organ and vital sign. It is a workable system when it is done well, but very expensive. And it is not done well mostly because it is very difficult to coordinate.
The “healthcare system” has under-invested in information technology forever. Because of its lack of a decent capital structure in provider areas and normal market feedback demands, it continues to massively under-invest while the quantity of information and knowledge that must be assembled at the point of service grows exponentially at an ever increasing pace.
And the receiver of the service, the patient, now the consumer, demands better and more accurate use of information and knowledge.
In delivering our health product there is always an interaction between two people. Hence, healthcare is a personal service . At its simplest, that means it is a service that one human being provides for the benefit of another. It is never free, of course. Beyond passivity, this results in the receiver having an “experience” and expectations for participation, access to information, convenience, choice, value, and even control. Not only has the patient/consumer experience been deteriorating in the past few years, it has now reached a point of misery and near universal antipathy.
Although there are many reasons for this, suffice it to say for now that part of the acceleration of this is a systematic exclusion of innovation at the point of service.
With the best of intentions of protecting the public from unscrupulous providers, there are government regulations (e.g., the Stark laws) that remove incentive for those who could do the innovation to engage the process. No incentive, no innovation. No innovation doesn't mean that things stay the same. It means things gradually deteriorate as expectations rise.
In summary, then, healthcare is a technology-based (massive investment), information-dependent (limited by brain size and under-investment), personal service (negative investment and exclusion of innovation).
And what of the healthcare system? It is a cartel of interests. A cartel may be defined as a consortium of independent organizations formed to limit competition by controlling the production and distribution of a product or service. In this case it is also to control the cost of production and distribution, which now approaches $1.6 Trillion. OK, it's not OPEC but that ain't chump change either.
The cartel members are Government, Insurance, Employers, Physicians, Hospitals, and Pharmaceuticals. There are a number of subsidiaries that play important roles as well.
Welcome to the cartel.
Why are there no consumers in the cartel? To be continued.
