Lightning Goes To Ground
Wednesday, September 15, 2010
I honour in addition to admire Lucien Engelen, the spirit behind the REshape Center for Innovation at Radboud University Medical Center inwards the Netherlands, hence when he of late posted an article entitled, "10 TED talks that change(d) healthcare," I was intrigued. Who doesn't dear TED talks, after all?
But in addition to hence I concluded that he was off base.
Not because the talks aren't great. They are great. They are stimulating, good presented, thoughtful, in addition to challenging.
But they receive got non changed wellness care. Look through the talks in addition to reckon what's imagined inwards them. Now, compare them to what's happening on the the world inwards most places.
(By most places, I am talking most the economically developed countries.)
What nosotros reckon inwards those countries is the presence of ii inexorable forces. One strength comprises underlying demographic factors. The quondam are living to an ever-older historic menstruum in addition to are putting unprecedented demands on the wellness attention scheme every bit nosotros accept attention of their chronic in addition to shrewd illnesses. Meanwhile, the adjacent generation (the Baby Boomers) receive got entered the historic menstruum of hospitalization, compounded past times an extremely high grade of entitlement. ("I wound my knee articulation playing soccer. I demand to hold upwards able to play every bit shortly every bit possible. I demand an MRI in addition to arthroscopic surgical operation to repair that rip.") And, finally, the adjacent generation is characterized past times a sedentary lifestyle, which has in addition to volition Pb to obesity, diabetes, in addition to the sequelae of those diseases.
Meanwhile, inwards the human face upwards of this demand, pharmaceutical in addition to applied scientific discipline companies invent novel diagnosis, treatments, equipment, in addition to supplies. They seek to grab their percentage of the growing wellness attention budget. Very few of their inventions, whether efficacious or not, lower the cost of wellness care. They tend to hold upwards additive. (And, past times the way, many are non efficacious.)
So what nosotros notice only about the globe is a persistent increase inwards wellness attention expenditures. Because at that topographic point is a limit to society's powerfulness to absorb such expenses, the costs are beingness pushed down--step past times step--to those to the lowest degree able to seek alternatives, the full general public.
Daniel Palestrant, the highly thoughtful CEO of Par80, has recognized this phenomenon in addition to has likened it to Benjamin Franklin's most of import invention, the lightning rod:
In this country, when it comes to healthcare, lightning has indeed struck. Like a bolt of lightning hitting a colonial edifice (which were largely made of wood), the unloose energy must notice a path to the world every bit apace every bit possible, scorching everything on the agency down. The query isn’t whether it volition notice ground, it is alone how much collateral harm it volition do every bit it gets there. The healthcare crisis is lightning hitting our society. If it isn’t managed carefully, it volition give the axe downward the house.
As healthcare costs receive got exploded, the cost in addition to responsibleness has been shifted from individual companies paying for employee benefits, to physicians, to insurance companies, the American taxpayer, in addition to most recently, the Chinese (who nosotros receive got been quest to lend us the coin to pay for these costs). In turn, each of these parties has at nowadays found a agency to either defer the liability or signal they are no longer willing to finance the endeavor to sustain the condition quo.
Lightning grounds when costs in addition to responsibleness are shifted dorsum to the alone remaining entity….the patient. That’s where nosotros are heading.
Daniel offers a hopeful prediction:
It’s non all bad, though. Directly engaging consumers inwards their ain healthcare volition inevitably Pb to ii trends:
Disintermediation - As the lightning accelerates, it volition facial expression to cutting out every bit many intermediaries every bit possible.
Price to Value - Once consumers are to a greater extent than responsible in addition to accountable for the cost in addition to mode of their ain care, it volition decease to a greater extent than probable that healthcare goods in addition to services volition hold upwards priced on relative value, rather than an arbitrary value laid past times a tertiary party.
Well, maybe. I mean value that some consumers volition receive got those opportunities, but I mean value that most volition not. Taking only i recent item, the tendency to high deductible wellness plans, nosotros already reckon the increase of inequity based on income. Lower wage people select the high deductible plans to cut their monthly premium, but in addition to hence they systematically select to avoid spending to a greater extent than of their disposal income past times deferring or avoiding appropriate medical care.
As the Institutes of Medicine recognized years ago, a wellness attention scheme that is non equitable is i that fails.
I bet if nosotros surveyed the viewers in addition to listeners of TED talks, nosotros would notice a bias towards higher educated in addition to wealthier people. Sure, they're actually excited most the ideas Lucien proclaims every bit changing the scheme inwards the management of higher quality, greater safety, in addition to lower costs. And sure, many firms inwards the marketplace volition aim their products in addition to services to those groups. How much volition trickle downward to the balance of society?
My fearfulness is that what trickles downward volition not hold upwards the innovations that withdraw most higher quality, greater safety, in addition to lower costs. What makes me pessimistic?
Frauds already abound, attacking the economically weakest inwards society. As Al Lewis, Vik Khanna in addition to Shana Montrose receive got unnecessary costs. I've pointed out how the medical-industrial-government complex aids in addition to abets such practices through opaque rate-setting in addition to rule-making procedures highly influenced past times those same companies. When those higher costs larn passed along direct to consumers, they human activeness every bit a regressive taxation on those amongst lower incomes. When they larn passed through indirectly through Medicare, they terminate upwards stretching the government's budget. Searching for budget relief, CMS engages inwards arbitrary penalties for failure to come across arbitrary lineament metrics. Which organizations tend to do worse on those metrics in addition to pay the penalties? The hospitals serving the lower income portions of society.
Let's facial expression at other industries that receive got moved inwards the directions predicted past times Daniel for wellness care--disintermediation in addition to price-to-value--like finance in addition to banking in addition to telecommunications.. While nosotros tin betoken to overall societal gains inwards each of these fields, the predominant business office of the value obtained from these structural changes has tended towards the wealthier components of society. Why should nosotros await wellness care--which is intensely to a greater extent than complex than whatever of those other sectors--to deport otherwise?
I don't offering these thoughts out of some socialist wishing or expectation. I offering them to remind Lucien in addition to others that their chore isn't done until or unless at that topographic point is a greater democratization of the benefits of all those innovations. That democratization volition non arise from lovingly produced TED talks viewed past times the elite inwards society. It volition require a motion from the patient advocacy world.
That world, however, remains inchoate. Many patient advocates larn inwards to this plain every bit a lawsuit of personal injury to themselves or a loved one. They are non trained inwards the skills needed to construct coalitions. They are on their own, without sufficient resources to larn their ain discussion out, much less receive got the fourth dimension in addition to unloose energy to come across amongst other in addition to construct a national movement.
There is no established scheme inwards America or, from what I receive got seen, other countries that has devoted itself to the advertisement of a vibrant, widespread patient advocacy movement. Those that powerfulness receive got done hence receive got shied away from this form of engagement--perhaps because they know that whatever motion hence constituted volition hold upwards unpredictable in addition to beyond their control. Yes, some hospitals seriously essay to engage patients inwards a clinical partnership, using advisory councils in addition to the like, in addition to these efforts are useful. But they alone decease hence far inwards that they are islands of activity amongst footling or no crossover beyond the catchment areas of each infirmary system.
Years ago, I came to know a wonderful man, V.B. Mishra, who was engaged inwards trying to halt the pollution of the Ganges River. He decried the lack of political back upwards for this effort, saying, "The river needs its Gandhi." Well, the truth of the affair is that Gandhi's in addition to Mandela's in addition to M.L. King's come upwards along rattling seldom in addition to commonly alone inwards times of swell alter in addition to crisis. During most times, it is non a unmarried leader who brings most change: It is a coalition of many local leaders who figure out how to bring together hands in addition to withdraw persistent pressure level on the torso politic. Until the patient advocates figure out a agency to create that coalition, the lightning volition decease to the world inwards a mode that many of us volition consider inequitable in addition to inconsistent amongst the objectives of political stability in addition to economical prosperity for all.
But in addition to hence I concluded that he was off base.
Not because the talks aren't great. They are great. They are stimulating, good presented, thoughtful, in addition to challenging.
But they receive got non changed wellness care. Look through the talks in addition to reckon what's imagined inwards them. Now, compare them to what's happening on the the world inwards most places.
(By most places, I am talking most the economically developed countries.)
What nosotros reckon inwards those countries is the presence of ii inexorable forces. One strength comprises underlying demographic factors. The quondam are living to an ever-older historic menstruum in addition to are putting unprecedented demands on the wellness attention scheme every bit nosotros accept attention of their chronic in addition to shrewd illnesses. Meanwhile, the adjacent generation (the Baby Boomers) receive got entered the historic menstruum of hospitalization, compounded past times an extremely high grade of entitlement. ("I wound my knee articulation playing soccer. I demand to hold upwards able to play every bit shortly every bit possible. I demand an MRI in addition to arthroscopic surgical operation to repair that rip.") And, finally, the adjacent generation is characterized past times a sedentary lifestyle, which has in addition to volition Pb to obesity, diabetes, in addition to the sequelae of those diseases.
Meanwhile, inwards the human face upwards of this demand, pharmaceutical in addition to applied scientific discipline companies invent novel diagnosis, treatments, equipment, in addition to supplies. They seek to grab their percentage of the growing wellness attention budget. Very few of their inventions, whether efficacious or not, lower the cost of wellness care. They tend to hold upwards additive. (And, past times the way, many are non efficacious.)
So what nosotros notice only about the globe is a persistent increase inwards wellness attention expenditures. Because at that topographic point is a limit to society's powerfulness to absorb such expenses, the costs are beingness pushed down--step past times step--to those to the lowest degree able to seek alternatives, the full general public.
Daniel Palestrant, the highly thoughtful CEO of Par80, has recognized this phenomenon in addition to has likened it to Benjamin Franklin's most of import invention, the lightning rod:
In this country, when it comes to healthcare, lightning has indeed struck. Like a bolt of lightning hitting a colonial edifice (which were largely made of wood), the unloose energy must notice a path to the world every bit apace every bit possible, scorching everything on the agency down. The query isn’t whether it volition notice ground, it is alone how much collateral harm it volition do every bit it gets there. The healthcare crisis is lightning hitting our society. If it isn’t managed carefully, it volition give the axe downward the house.
As healthcare costs receive got exploded, the cost in addition to responsibleness has been shifted from individual companies paying for employee benefits, to physicians, to insurance companies, the American taxpayer, in addition to most recently, the Chinese (who nosotros receive got been quest to lend us the coin to pay for these costs). In turn, each of these parties has at nowadays found a agency to either defer the liability or signal they are no longer willing to finance the endeavor to sustain the condition quo.
Lightning grounds when costs in addition to responsibleness are shifted dorsum to the alone remaining entity….the patient. That’s where nosotros are heading.
Daniel offers a hopeful prediction:
It’s non all bad, though. Directly engaging consumers inwards their ain healthcare volition inevitably Pb to ii trends:
Disintermediation - As the lightning accelerates, it volition facial expression to cutting out every bit many intermediaries every bit possible.
Price to Value - Once consumers are to a greater extent than responsible in addition to accountable for the cost in addition to mode of their ain care, it volition decease to a greater extent than probable that healthcare goods in addition to services volition hold upwards priced on relative value, rather than an arbitrary value laid past times a tertiary party.
Well, maybe. I mean value that some consumers volition receive got those opportunities, but I mean value that most volition not. Taking only i recent item, the tendency to high deductible wellness plans, nosotros already reckon the increase of inequity based on income. Lower wage people select the high deductible plans to cut their monthly premium, but in addition to hence they systematically select to avoid spending to a greater extent than of their disposal income past times deferring or avoiding appropriate medical care.
As the Institutes of Medicine recognized years ago, a wellness attention scheme that is non equitable is i that fails.
I bet if nosotros surveyed the viewers in addition to listeners of TED talks, nosotros would notice a bias towards higher educated in addition to wealthier people. Sure, they're actually excited most the ideas Lucien proclaims every bit changing the scheme inwards the management of higher quality, greater safety, in addition to lower costs. And sure, many firms inwards the marketplace volition aim their products in addition to services to those groups. How much volition trickle downward to the balance of society?
My fearfulness is that what trickles downward volition not hold upwards the innovations that withdraw most higher quality, greater safety, in addition to lower costs. What makes me pessimistic?
Frauds already abound, attacking the economically weakest inwards society. As Al Lewis, Vik Khanna in addition to Shana Montrose receive got unnecessary costs. I've pointed out how the medical-industrial-government complex aids in addition to abets such practices through opaque rate-setting in addition to rule-making procedures highly influenced past times those same companies. When those higher costs larn passed along direct to consumers, they human activeness every bit a regressive taxation on those amongst lower incomes. When they larn passed through indirectly through Medicare, they terminate upwards stretching the government's budget. Searching for budget relief, CMS engages inwards arbitrary penalties for failure to come across arbitrary lineament metrics. Which organizations tend to do worse on those metrics in addition to pay the penalties? The hospitals serving the lower income portions of society.
Let's facial expression at other industries that receive got moved inwards the directions predicted past times Daniel for wellness care--disintermediation in addition to price-to-value--like finance in addition to banking in addition to telecommunications.. While nosotros tin betoken to overall societal gains inwards each of these fields, the predominant business office of the value obtained from these structural changes has tended towards the wealthier components of society. Why should nosotros await wellness care--which is intensely to a greater extent than complex than whatever of those other sectors--to deport otherwise?
I don't offering these thoughts out of some socialist wishing or expectation. I offering them to remind Lucien in addition to others that their chore isn't done until or unless at that topographic point is a greater democratization of the benefits of all those innovations. That democratization volition non arise from lovingly produced TED talks viewed past times the elite inwards society. It volition require a motion from the patient advocacy world.
That world, however, remains inchoate. Many patient advocates larn inwards to this plain every bit a lawsuit of personal injury to themselves or a loved one. They are non trained inwards the skills needed to construct coalitions. They are on their own, without sufficient resources to larn their ain discussion out, much less receive got the fourth dimension in addition to unloose energy to come across amongst other in addition to construct a national movement.
There is no established scheme inwards America or, from what I receive got seen, other countries that has devoted itself to the advertisement of a vibrant, widespread patient advocacy movement. Those that powerfulness receive got done hence receive got shied away from this form of engagement--perhaps because they know that whatever motion hence constituted volition hold upwards unpredictable in addition to beyond their control. Yes, some hospitals seriously essay to engage patients inwards a clinical partnership, using advisory councils in addition to the like, in addition to these efforts are useful. But they alone decease hence far inwards that they are islands of activity amongst footling or no crossover beyond the catchment areas of each infirmary system.
Years ago, I came to know a wonderful man, V.B. Mishra, who was engaged inwards trying to halt the pollution of the Ganges River. He decried the lack of political back upwards for this effort, saying, "The river needs its Gandhi." Well, the truth of the affair is that Gandhi's in addition to Mandela's in addition to M.L. King's come upwards along rattling seldom in addition to commonly alone inwards times of swell alter in addition to crisis. During most times, it is non a unmarried leader who brings most change: It is a coalition of many local leaders who figure out how to bring together hands in addition to withdraw persistent pressure level on the torso politic. Until the patient advocates figure out a agency to create that coalition, the lightning volition decease to the world inwards a mode that many of us volition consider inequitable in addition to inconsistent amongst the objectives of political stability in addition to economical prosperity for all.