Revamping the health care system
[Cross-posted from here. ]
In an interview with New York Times, Harvard Business School professor Clayton Christensen offers some radical proposals to improve the US health care system (link via).
Prof Christensen believes that the current system is woefully inefficient in terms of affordability and accessibility. His basic premise is that with advances in medical diagnoses and cures, treatment of certain diseases should be more widely available rather than being restricted to a handful of trained professionals (ie doctors) and institutions (hospitals).
The whole interview is worth reading, but here are some parts that I found intriguing.
Q. The nation’s medical system is regularly offering increasingly advanced procedures and treatments. Isn’t that a good thing?
A. If you look at the progress that today’s hospitals and the medical profession have made, they continue to push the leading edge of what’s very difficult to do. But that’s a very different dimension of performance improvement than the one that makes more people better off, and that is making it affordable and accessible. In other industries, whenever affordability and accessibility have come, it has not come from making mainframe computers better but rather from commoditizing mainframes so that average people with average money can have access to high-quality computing, meaning personal computers. It came from disruptive technology rather than improvements on the existing system. Michael Dell could assemble one of these things in his dorm room.
Q. What’s the relevance to health care?
A. In health care, rather than replicating the expensive expertise of Mount Sinai Medical Center or Mass General Hospital or replicating the expensive expertise of doctors, we have to commoditize their expertise. That comes through the precise ability to diagnose the diseases that people have. Our ability to diagnose the diseases is moving ahead at a breathtaking pace, but regulation and reimbursement are trapping the delivery of rules-based medicine in high-cost business models.
Q. Are you saying doctors rather than the pharmaceutical industry are the root cause of what’s gone wrong?
A. The pharmaceutical industry has been focused on therapy, not diagnosis. The medical profession has simply accepted that many of these diseases are well-diagnosed, when in fact they aren’t. As a consequence, we haven’t moved the health care profession into a world where nurses can provide diagnosis and care. Regulation is keeping the treatment in expensive hospitals when in fact much lower cost-delivery models are available.
Q. Wouldn’t your solution require a dramatically different regulatory environment?
A. It differs state by state. In Massachusetts, nurses cannot write prescriptions. But in Minnesota, nurse practitioners can. So there has emerged in Minnesota a clinic called the MinuteClinic. These clinics operate in Target stores and CVS drugstores. They are staffed only by nurse practitioners. There’s a big sign on the door that says, “We treat these 16 rules-based disorders.” They include strep throat, pink eye, urinary tract infection, earaches and sinus infections.
These are things for which very unambiguous, “go, no-go” tests exist. You’re in and out in 15 minutes or it’s free, and it’s a $39 flat fee. These things are just booming because high-quality health care at that level is defined by convenience and accessibility. That’s a commoditization of the expertise. To have those same disorders treated in Massachusetts, you’ve got to go to a regular doctor, go through a long wait in their office, you go in and see the doctor for two minutes. He says, “You have an earache,” which you knew already, and then they charge you $150.
Having gone through the experience of being offered an appointment three weeks in future for a current cold symptom, and then having to wait hours in various rooms to see a doctor for ten minutes, the idea of such small clinics are particularly welcome (there is actually one being built alongside our neighborhood Eckerd).
My main question is whether medical science is really at that stage when a majority of diagnosis can be confidently prescribed by such ‘go, no-go’ metrics ?
The professor also talks about the problem of having non-integrated players in the health care system:
The current health care system is divided into buckets. You have the insurers, the employers who put up the money, the providers such as doctors and nurses, and the hospitals. Because they exist as independent companies, they can each improve themselves, but they can’t re-architect the system in the way that it needs to be changed.
There are two health care systems in the West, Intermountain Health Care in Utah and Kaiser Permanente in California, that are in fact integrated across each of those pieces of the system. They are far ahead of the rest of the world in bringing rules-based diagnosis and therapy in cost-effective business models to their patients.
Of course, all these changes cannot happen without a strong will from the government to overcome the regulatory framework of the current system.
The government will be the hardest because a lot of the regulations that require that care be given by people with particular expertise and in expensive hospitals were put in place during a prior era when the science was not really as well-defined. The regulations just haven’t kept up with the science.