Health Care’s Bully: Free

Free (paying nothing, receiving something) is definitely here. Well, it’s been “here” for a long time. It’s just acknowledged now. The web is built on free and its implications are widespread, blanketing every industry…and that includes health care. We have reached the point that any new business is seemingly building itself upon the Free model. As for health care and “old business,” the Free concept must not be ignored.

My discovery of Free insight transpired over the course of a few weeks and it started with Chris Anderson’s FREE! article in Wired, which is also the title of his upcoming book. Then I came across “Free Love” at Trend Watching. And then Free spread with many weighing in across the intraweb. PSFK has some highlights of Free. Blogspotting mentions our (humans) infatuation with Free and asks how to make a living on Free. As Seth Godin writes, the interaction completely changes when something is Free, “There is no commitment, one way or the other, for free.”

Health care analysis started with Health Populi and the free implications on health care information technology, especially web based Health 2.0 applications. This is a good place to start the Free health care discussion—it’s the first aspect of health care delivery to move digital—because as Chris Anderson says, “Every industry that becomes digital, eventually becomes free.”

The broader implications of Free health care are sure to send any old economy organization/service provider running. Look at some of the services that have gone digital, services that people once shelled out significant money for: university classes (download an entire MIT class or view lectures at UC Berkeley), scientific knowledge (a new(er) group of journals at PLoS allows the viewing of articles for free), communication (think of the email, instant messaging, or Skype calls one can do on free wireless networks), the list could go on for a quite a while.

Fred Fortin at the World Health Care Blog goes further in analysis, “The real and most interesting question has to do with the impact of free healthcare on those aspects of healthcare for which we pay dearly.” As we know, a provider’s response to payer reimbursement cuts is simple: increase volume. When actual health care services delivery is wholly affected by Free, volume increases will do nothing to supplement an entire decrease in reimbursement. It’s happening already, primary care physicians exchange email and phone calls with patients, in essence providing care, but unfortunately are not being paid for it. The real bad news for physicians, as is demonstrated by the music industry, is that once you start providing a service for Free, there is no way to return to the model of compensation, no matter the amount of litigation.

As we increasingly push health care digital (read: the web), how can we create value in a world dominated by Free? The important debate: not how can we prevent health care from becoming Free but how to add value in order to make money.

Kevin Kelly at The Technium offers, what else but, some free advice: It starts with examination from the user’s perspective, “why would we ever pay for anything that we could get for free?” Mr. Kelly goes on to describe eight generatives to combat free. “A generative value is a quality or attribute that must be generated, grown, cultivated, nurtured. A generative thing can not be copied, cloned, faked, replicated, counterfeited, or reproduced. It is generated uniquely, in place, over time.” Read about them here. Four generatives that I think will have the largest impact on health care: immediacy, personalization, interpretation, and findability. Feel free to comment on your thoughts.

But here’s the good news, the World Health Care Blog asks, “Healthcare is a late bloomer when it comes to the information technology revolution, but it will, as they say, suffer from 100 percent of the effects of that technology. Are we prepared and being mindful of the changes all around us? That remains to be seen.” As recently reported in The New York Times, late adopters are important in the technology adoption cycle.

The health care industry, being the late bloomer that it is (that’s putting it nicely), allows itself to learn from the trials and tribulations of the rest of the industrialized world. The feet dragging in health care gives us a window (although quickly closing it is) to research, test, and implement models that will work. Some have already started, don’t be left behind.