What do you Want from Health Care?

I posed the following challenge to the Innovations in Health group on Linkedin and got some interesting responses, including a well crafted wish list from Colleen that inspired this blog post.

HOW CAN WE STIMULATE INNOVATIVE IDEAS FOR A TOTALLY NEW HEALTHCARE SYSTEM?

As a fun exercise to stimulate creative, out-of-box thinking, pretend you have all been been appointed to the new World Health Commission by the new King of the World (or whatever title you prefer). You have absolute power to determine health strategy, for the whole world. Think like a child, and forget the constraints you’re used to dealing with as adults. There are no financial hurdles, no political worries, no cultural barriers, no legacy to contend with, no managers looking over your shoulders, and no imposed time frames.

What is it that patients, providers and society seek from healthcare? Why can’t they get that now? Starting with a completely blank canvas, what would be the objectives of the new System? Imagine potential roadblocks and how we might overcome them.

COLLEEN: Since we are dreaming here: Let me tell you what I want. I want to go to a doctor with whom I have a long-term relationship and who knows me and my history. I want to be seen today or tomorrow if I am sick and within 2 weeks if I need a check-up. At least once a year I want a thorough exam, with all of the tests that are appropriate for my age and condition. I want to sit down with my doctor to plan a strategy whereby I might improve my health status. That would include recommendations about nutrition and supplements, exercise and other activity, stress reduction and anything else that the doctor may sense that I need. I don’t want to be rushed or wait forever in the office.

In addition to my doctor, I would like to consult with and be treated by complementary professionals such as nutritionists, physical therapists, massage therapists, and others according to my need. I want the freedom to choose my own therapies after being well educated by competent professionals. I don’t want to pay extra so that others, who choose to neglect themselves, may receive heroic measures for illnesses that they could have prevented.

Perhaps, there could be groupings of professionals who would have confidence in each other for the purpose of referrals, a team, if you will, who would work together to benefit the client/patient. Electronic records, with appropriate privacy and confidentiality built in would allow all of the practitioners to add information that could be coordinated by the private physician, and to eliminate duplication of tests and input. Drugs would be used as a last resort rather than the first. Creating vigor and vibrant health would be the primary goal.

I like the concierge model with the emphasis on preventing illness, combined with health savings accounts, and catastrophic care insurance. They are a win for both doctor and patient. All those other folks would need to find new jobs (perhaps something that would produce a greater value), but eventually it would be better for them and the economy too.

Colleen’s wish list probably represents that of most Americans, even the comment about, “I don’t want to pay extra so that others, who choose to neglect themselves, may receive heroic measures for illnesses that they could have prevented.” (I like how she put it.)

Many people view car insurance that way too and are attracted by policies that offer low rates to good drivers and even lower rates if they’ll agree to install a monitoring device with GPS that lets the insurance company track their destinations and driving habits and match actual speed to speed limits at any location. Parents are more likely to do that for their teen’s car. They give up some privacy but get lower rates and information about their kids.

What would you give up for lower rates on health care?

Would you see a nurse or physicians’ assistant instead of a doctor if they visited your home when you needed them, and they were backed up by powerful computer systems that amplified their abilities? Some people may be willing to pay a premium for that. Here are two related articles:

1. Supporting Health Workers on the Front Lines
2. IBM’s Jeopardy-winning computer is delving into medicine

The first article by Melinda Gates is about innovative health care in sub-Saharan Africa and suggests that face-to-face interaction is often more beneficial than extensive training. The second is about IBM’s plans to extend the power of its Jeopardy-winning supercomputer to the task of medical diagnoses and treatment. Think of combining the two: medical staff with less training but with more computer support. That may be a way of addressing the physician shortage, which is getting worse.

What if the care was provided remotely using electronically monitored sensors and video calls rather than in-person visits in your home or doctor’s office?

Again, you could get care and medical advice whenever you needed it, 24x7x365. Or maybe you’d prefer to access medical information online yourself, including your personal health records.

If the medical professional at the other end of the line was remote, would it bother you if they were in another city and if they were a nurse or PA, again with great computer support? What if they were in another COUNTRY?

See Are we bringing health care Home or sending it Overseas? because Internet connections to Asia and India are far faster than most parts of Alabama and Indiana. That makes it easy to outsource knowledge-based jobs to places with lower wages, like Bangladesh.

To me, these trends suggest that if you’re planning to go into the medical field as a career, you may want to pick a high-touch specialty that requires personal contact and can’t be outsourced, like a chiropractor, physical therapist, or a labor & delivery nurse. Even surgery these days can be done remotely through a combination of telemedicine and robotics. In-home care will be in high demand due to the demographic shift, but practitioners may need less skill in the future if my vision of converging disciplines is correct.