In: Important Answers

Has health care growth been riding a wave of faulty demand?


In this age of consumer-driven health care, will Americans react like retail consumers—switching aggressively to generic drugs and shopping around for cheaper docs? Or will they act like car buyers—reducing their purchases of health care, avoiding doctors, and letting prescriptions go unfilled?

Likely to be a combination of the two.  Free generics and Health 2.0 tools make the former scenario plausible.  Employment cutbacks make the latter probable.

Just making sure…

How would you reform health care?  What do you think is health care’s most significant problem?  It’s greatest opportunity?  If you could change one thing about the way health care is delivered in this country, what would it be?

Any of the above (or extension thereof) should be a part of every conversation with any new perspective health care hire.

The answers are not not of much importance.  Heck, the ideas discussed could be as good as prohibition, it’s of little interest (unless it’s really good!).

All you want to know is that a candidate has ideas.

Why?  The money-makers have very little time left enjoying our current system of care (“enjoy” used in the lightest terms possible).  We’re going to need a healthy mix of new thinkers with new ideas to mingle with the wily veterans to help us through the nasty transition.

The important questions

Some have scoffed at the idea of traveling to India or Thailand for medical care.  How about New Zealand for the same reason?  They speak English and have such American necessities as McDonalds and Starbucks.  Rumor is the scenery is beautiful, too.

Medtral is hoping that an experience similar to that found in the United States will be the reason American health care travelers choose New Zealand for their next hip replacement.  From The Washington Post: “The company says it can offer procedures at boutique hospitals with follow-up personal nursing care at a fraction of the cost of the same surgery in the United States.”

Only 30 North Americans have registered with the company in ten months of existance.  The article also says that cost comparisons are difficult because of the variability in pricing across the U.S.  Medtral is focusing on a market they estimate at 75 million uninsured and underinsured Americans.

Here is the most important point, however:

“If my insurance company will cover the major share of the cost of the procedure, then I’m inclined to have it done here in California, since my biggest concern is what if something goes wrong,” says Shaw, an eighth-grade teacher from Mountain View, Calif. “I really don’t want to have to travel back to New Zealand for the sole purpose of doctor visits. That’s a bit expensive on a teacher’s salary.” If his insurer balks at the U.S. expenses, he is ready to make the case for traveling to New Zealand.

It always comes back to what patients will have to spend out of pocket.  Cost savings must be equivalent to the extra effort required to receive care in New Zealand (or any other country, for that matter). Getting a knee replaced requires significant rehab time and a few follow-up visits.  Turns out those tasks are easier to accomplish when the services are provided a few miles from the home rather than around the world.

“Will my insurance cover it?” and “How much is it going to cost me?” have been, and will continue to be, more important questions than “Who is doing my procedure?” and “Where is my procedure being done?”

That doesn’t seem right.

4. Ask Questions. From the Start. Constantly.

Dr. Michael Wilkes writes a great editorial.

“What is the role of a doctor?”

Starting right now, what do you want from your doctor?

Dr. Wilkes provides a few suggestions from an audience he recently spoke to:

  • Knows me and my family.
  • Is a good listener.
  • I can reach when I get sick – even on weekends.
  • Is working for me – not an insurance company or a hospital.
  • Cares.
  • Treats me with dignity and respect.
  • Won’t go home because their shift is over with my problem still unresolved.
  • Explains things so I can understand them.

Dr. Wilkes was struck by something that wasn’t on the list, “No one – not a single person – said they wanted the smartest doctor or a doctor who was an expert at medicine.”

Anyway his point: asking (and answering!) this question delivers two things: 1) insight on how to retool medical education and 2) information we can use to measure performance.

Two extremely relevant and important things. But I don’t think we should stop there. What do nurses expect from physicians? How about hospitals? Other relevant stakeholders?

And once that process has started we need to start asking questions about our hospital. What do patients want from the hospital? What does the community want from the hospital? What do providers expect from the hospital?

And we won’t stop there. Questions will be asked about, and of, all providers. Processes will be questioned. Governing bodies will be questioned. The analyses will continue until all have been analyzed and the questions have been answered.

These discussions, though time consuming (this is the greatness of being a virtual system), will lay out expectations from the start. These discussions will allow us to deliver the best care possible. Our expectations of each other will be on the table allowing us to focus on what matters most: patient care.

Principle #4: Asking questions not only promotes learning, it encourages discussion. We will ask questions from the beginning. And not stop. Incessant questions = incessant improvement!