The Healthcare System's Dirty Secrets | Big Think
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- čas přidán 31. 07. 2024
- The Healthcare System's Dirty Secrets
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Insurance companies are rewarded for excluding sick people, says Harvard Business School professor Michael Porter.
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Michael Porter:
Michael Porter is generally recognized as the father of the modern strategy field and has been identified in a variety of rankings and surveys as the world’s most influential thinker on management and competitiveness. He is also a leading authority on the application of competitive principles to social problems such as health care, the environment, and corporate responsibility. Porter is the Bishop William Lawrence University Professor at the Harvard Business and the author of 18 books and over 125 articles. He received a B.S.E. with high honors in aerospace and mechanical engineering from Princeton University in 1969; an M.B.A. with high distinction in 1971 from the Harvard Business School, where he was a George F. Baker Scholar; and a Ph.D. in Business Economics from Harvard University in 1973. In 2001, Harvard Business School and Harvard University jointly created the Institute for Strategy and Competitiveness, dedicated to furthering Porter’s work.
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TRANSCRIPT:
Topic: Healthcare: Problems and Solutions
Porter: The fundamental problem with healthcare in the US and many other countries as well by the way is that the system is not really organized and structured around delivering value for the patient.
Michael Porter, Professor, Harvard Business School.
Question: Where did the healthcare industry go wrong?
Porter: We have a system where in America particularly we don’t have everybody covered by an insurance system and the insurance system that we do have is again not structured around value. Insurance companies have been rewarded for actually excluding sick people and their modus operandi is to bargain down prices with providers rather than actually improve the health of their subscribers. We don’t even know if insurance companies do a good job of actually assisting their members or their subscribers in improving their health conditions and so the insurance market has been really not rewarding value but really rewarding cost shifting, pushing cost from one entity to the another, passing more cost on to the consumers. So the insurance system is really a key part of a problem. But what we, I think understand now is the real fundamental problem is that we’re not delivering healthcare in a way that creates value or the maximum value for the customer and that’s fundamentally because the organization of healthcare is misaligned with really the needs of the patient. Healthcare is organized around specialties and interventions. You go to the radiologist, you go to the internal medicine person, you go to rehab, these are all separate departments, separate people, separate interventions with separate administrative structures, but that’s not what creates value. What creates value is really to integrate all the expertise and specialties and interventions necessary to address the patients' medical condition-whether it’s diabetes or heart problem or an arthritic hip-over the full cycle of care of that patient, and fundamentally then the organization of the delivery of care is really not organized around the patient and the value for the patient but it’s really organized around the traditional divisions and specialties in the field. And what makes it worst is that we don’t actually measure the value delivered, we don’t even measure health outcomes at all except in very rare cases. So it’s very hard to drive value in a system where value really isn’t measured and where pricing actually reinforces the fragmentation and lack of coordination in the system. Today, we pay for services basically, we pay the doctor separate from the hospital, we pay the radiologist separately from the surgeon, we pay the surgeon separately from the anesthesiologist, we pay the office visit separately from rehab and essentially the payment system then simply encourages people to do more services, rather than to optimize the overall value that is delivered in terms of the patient outcomes per dollar spent. So we’ve got a real mess in our hands because the structure of the system is really fundamentally disconnected to value.
Question: What can we do to improve the system?
Read the full transcript at bigthink.com/videos/the-healt...
Totally agree with You when you suggest the shift away from the Process management approach to the Outcome management approach.
Totally SUPER COOL ! Thanked a Dr. Today. 💌
an abscess tooth could cost me around 3500 bucks and that's with gold tier health insurance as a public sector employee in the USA
Thanks for focusing on this topic! Writting article about that and sent a copy.....Show how the privatization, deregulation and marketisation of US Heathcare System did make it easier for it to be one of the most expensive, exclusive and inefficient of the world. Fortunately, you're suggesting business model and technology that can help. 1. Patient-centered Care Model can help. 2. Shared Value Business Model and Technology can help. Among others! I'll be back soon as well with another article regarded to COVID and US Healthcare System.
He says nothing about greed which is the most infectious aspects of health care...just like a disease.
Disagree on many points:
Firstly, it's not the insurance companies job to keep you healthy, just as it's not geico's job to make sure you're a good driver, just to charge you according to your driving skill and past record.
The incentive to be healthy is for your own self interest in your health as well as incentive for low insurance.
If you had preexisting conditions, you were dealt a bad hand. Private subsidies can solve that (charity.)
It's the insurance companies job to do the following: Insure you when you are sick and need medical attention. ANYTHING else, is up to personal responsibility. Having an insurance company bargain with the hospital is beneficial, they are saving you money.
I agree the payment system is poorly operated, likely due to government regulations.
If you want to save people money, deregulate the medical industry!! Look at India as an example- you can get a bypass surgery for 1% of the cost of US, WITHOUT insurance.
Compare health care systems, the fewer regulations and the less government intervention in the market- the better and cheaper the care.
In America....95% of all diseases.....other than true DNA genetics derived diseases.....could be gotten rid of by eating "real foods". Period.
We're fundamentally disconnected from what we should be eating. We don't need tainted foods with pesticides from Monsanto and others....killing us insidiously....and the food absolutely is....this is fact....not speculation.
Eat well....live well, without the interventional nonsense of a modern medical system.
If we don't increase our natural foods....like "that eaten , 100 years ago"....we're doomed. "It's just that simple".
Food,....is the most fundamental issue of health...not an imaging technique, education, having telemedicine,....visiting nurses, etc. Not robotic surgeries,....not an intelligent, interactive IT database....not anything but food.
Quality foods....quality lives. Now....why can't we spend the CMS monies on the "issues that really matter?"....like organic foods,....and the real issues that start and grow illnesses - improper foods. Our food industry is killing us today......and we need help getting free from this "MATRIX" of sorts scenario.
Having disparate DSRIP (delivery system reform Incentive payment) programs in the states, will create scales of efficiency....but this will simply enable our system to be more efficiently handle the numbers of increasing sick people, as a function of governmental mandates and the lobbyists that mandate more GMO's, more sugary food allowances, more low quality foods, etc.
Foods are the "missing link"....one can't "put Cocoa Puffs (McDonald's, Burger King, Wendy's, Five-Guys, In-and-out) in one's automobile" and more than they can put Cocoa Puffs, et al in one's body for long without destruction or chronic diseases. Period.
So....make 'proper foods available to the Medicaid/Medicare population....and see how fast they "snap back" as a N=large number study....Medicine would change overnight.
You have got it all wrong! India has a system like the one in US which means it is mostly insurance based (US have the highest costs in the world per capita for health care). India is not a good example since they do not have an universal health care system. People must pay considerable amount of money for advancd medical care! In the civilized countries a taxbased health care system is a standard soloution. So forget about the insurance companies they have hardly anything to do with healt care in our countries (the nordic countries). Sweden has a universal public health system paid largely from taxation in the same way as other Scandinavian countries. Sweden's entire population has equal access to health care services. The Swedish public health system is funded through taxes levied by the county councils, but partly run by private hospitals. Government-paid dental care for those under 21 years old is included in the system. Dental care above a fixed amount is also subsidised.
If the governement in USA created a health care system based upon taxes you would scream "this is communism".