Monday, January 09, 2006

A Theory

A Theory - I have a theory on the essential elements to creating the healthcare delivery system that we should have. It struck me recently that there are three elements that are required to get us there. Now they aren’t necessarily simple things, in fact, they are quite broad categories, but they seem to encapsulate, for me, the forces needed to accomplish this task.

The first element is the never-ending struggle for improvement. Complacency is one of the silent killers in healthcare. When we accept the status quo, convince ourselves that “we provide good care”, or just don’t know what to do next, then we will never move beyond the level of care provided today. This is a hard element because it asks everyone involved in the care process to question their own performance. There is always an opportunity to improve outcomes, reduce variability, share more information, and communicate more effectively.

The second element is technology. As I enter the world of healthcare technology, I am becoming more convinced that we need the tools of technology in order to provide safe and coordinated care. Over the next decade, there will be billions of dollars spent on healthcare IT, and, yet, the biggest hurdle to realizing technology’s potential to improve care is the re-imagination (I am borrowing that from the Toyota Avalon commercial) of the very way care givers provide care.

The third element is a commitment to make the system work for everyone. This one is a great challenge. It is easy (relatively) to build a system that is profitable. The challenge is to remember that there is an additional end to strive towards. To remember that after the business model works, we have to make it work for those who lack access.

I know that theories aren’t much use to people. A theory isn’t a proven fact. It may not solve anyone else’s problems. But, for me, it is a hunch; recurring themes that seem to pop up every time I read an article about the industry, come across a new idea, or wrestle with the big issues of healthcare. In this new year, and with my new role, I imagine that I will be writing more about these elements. I have to see if my theory is correct.


  • Andrew - great treatment of areas to address in our health care market. There is one, however, that never seems to get much attention - that was a critical issue back when I worked for an ehealth connectivity startup.

    Proponents of a single payer system say that the market driven approach to health care has failed, what with continued rising costs and less than 100% coverage of the population. The problem with this (and this is maybe the fourth element) is that our health care market is far from "market driven" - there are many distortions and indirect relationships between buyers and sellers, who pays and who benefits. I'm thinking about employers who pay for health care that is consumed by employees with little regard for cost or efficacy; or hospitals whose real customers are private practice physicians rather than patients; and payers who, through these distortions, wield power that is out of proportions to their theoretical role of managing risk.

    These distortions in our health care marketplace, mainly the result of regulation and politics, have created the biggest barrier to reforms and technology adoption that would improve outcomes, patient safety and increase coverage through lower costs. Because of these distortions, each player in the health care market asks, "what's in it for me?" when considering change or investing in technology - and frequently, because of these distortions there is in fact little in it for them because the benefits are accrued by someone else in the health care delivery chain.

    An ex-governor here in Oregon (and ex-emergency physician) is starting to make noise here about "reforming" the state's health care. His solution? Raise taxes (by eliminating employers tax deduction for health care costs) and providing universal coverage. A pretty unimaginative solution, in my opinion, and one bound to result eventually in government rationed care, continued cost increases, and only modest improvements in outcomes and patient safety.

    By Anonymous Tim Gee, at 5:06 PM  

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