WHY WE NEED GOVERNMENT IN HEALTH CARE

Hugh Hewitt interviewed Prof. Clayton Christiansen about his new book, The Innovator’s Prescription. The professor makes two great points, one about computer-based diagnostics and the other about system design.

The data we have on diagnostics can be automated to arrive at the most likely diagnosis and the preferred care:

CC: Well, what will happen is primary care doctors will disrupt physicians. So there are technologies now that will bring to the desk of the primary care physician the expertise to do things that in the past had required a specialist. For example, there’s a firm here in the Boston area called Simulconsult, that is starting out in neurological disorders, and then broadly expanding. And so if you as a patient present yourself to your primary care doctor, and the doctor judges that you’ve got a neurological problem, she’ll just input into the Simulconsult system the symptoms that she observes, and any test results that she’s collected. And the system will come back to her and say well, there’s a 68% probability that your patient has this disease, 17% that she has that disorder, 8% that it’s this one, and then there’s a long tail. Now collect these four other pieces of information from the patient if you would, please, and input them. And you put that in, and then the system comes back and says gosh, it looks like that what we thought was a 68% probability is a 93% probability that it’s this syndrome. The 17% idea looks like it’s dropped down. And now get two more pieces of information, and we’ll tighten it even further. And what they’ve done using the miracle of the internet is captured over 30,000 published studies of neurological disorders, and synthesized them in a way that is distills all of that expertise onto the desktop of your primary care physician, so she doesn’t have to refer you to the specialist, because that specialty expertise is right there.

The second point he makes is that the "invisible hand" isn't going to get the job done. Hewitt didn't make a stink about this.

CC: I’m not sure that the market will drive it, but management could drive it in the sense that Adam Smith in the Wealth Of Nations, the treatise of capitalism, introduced this construct called the invisible hand, that in competitive markets directs resources to the highest use. And there are just some problems where Adam Smith’s invisible hand is impotent. And it requires what Al Chandler calls the visible hand of managerial capitalism. And that means that there has to be an entity that has the scope that can wrap its arms around all of the pieces of the system to just re-architect it. And in most of America’s health care system, you don’t have that scope. ... But there are only a few institutions that we call in the book integrated fixed fee providers that have the scope to rethink it all. And some of those institutions are the military’s health system, the Veterans’ Administration health system, Kaiser Permanente in California, Health Partners in Minneapolis, Intermountain in the intermountain states. And what those institutions have is they control the payments or the insurance system, they employ doctors, they own the hospitals.