The United States has built a healthcare system on alluvial soil. Unfortunately there is little or no discussion around the precarious shift in the framework. We seem to be afraid to commit entirely to a market system or to declare healthcare as a human right. Oh sure we wordsmith and use fuzzy language like "access to healthcare" instead of going all in on a national healthcare system of providing healthcare.
The solution is easy. Healthcare for all? Make it a public utility and be done with it. The time for bold moves is dwindling. I am not so naive to think this is in the works but what I am suggesting--the problem has to be defined because the solutions are different.
For example, the US spends more on healthcare than the entire GDP of France, India, Italy, Brazil, or Canada. You could float the spend out as a country larger than the entire GDP of either of those listed countries. The image below, from JAMA demonstrates the source of the spending classifying diabetes, urogenital, blood, and endocrine diseases as its own category--DUBE.
We can't even agree on what type of system we have. Is it a free market? Well although based on demand and supply we do have government intervention through access and price control to some extent. Think formularies or approved drugs available through Medicare or Medicaid programs. Free markets are also characterized by voluntary participation and agreement on the price of a good or service.
When is the last time anyone voluntarily became ill enough to enter into the healthcare market? Can you negotiate on price when the costs are not transparent or the provider is also blind to cost information at the point of care?
I don't get warm and fuzzies when considering healthcare as a capitalist system either. Profit is the underlying motive with competition being the main driver vs. supply and demand of free markets. We are aware of the power of monopolies and how capitalism creates wealth in contrast with exchanges of wealth or goods and services in a free market.
If your only exposure to economic theory is the classical approach presented in introductory courses you may have heard about the rational consumer. This adds the interesting bias that we all make rational, well considered choices. Modern economics has upended this notion of rationality and revealed the complexity of our irrational brain and the heuristics and cognitive biases contained herein.
It is at the tension between concepts of an ill-defined healthcare framework and our irrational brains where I see opportunity. As a datapreneur I create, collect, and review research surveys. I think about them and try and adapt many for the challenges of creating better data. Carefully curated data reveals information but it means nothing if we are unable to qualify the biases and limits of measuring behavior.
The complexity of human behavior has earned several Nobel prizes and two of the scientists caught my attention along the way.
In addition to collecting robust research surveys I also collect quite a few horrible examples from measurements of healthcare provider behavior. Continuing medical education does a horrible job assessing physician learning. I would be happy not to have to look at another pre- and post- survey. There is a lot of magical thinking around the utility of influencing behavior by a limited intervention followed by measurement of the effectiveness of the intervention.
Contemporary discussions around how to facilitate meaningful behavioral change are powerful studies influencing not only political discourse but nudging changes in behavior in the face of new clinical evidence. It takes system thinking to integrate measures of moral domain and concerns to get closer to understanding how to introduce new information effectively or introduce evolving data to withstand the scrutiny of what we value at the point of care.
If you aren't measuring the potential role of moral judgement in prejudice--how do you know what you don't know?
Presenting at Destination: Patient Outcomes, Our Journey to Improving Patient care
Systems Thinker Approach: Finding, Analyzing, and Gathering Data Insights for Modern Continuing Medical Education
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In a world of "evidence-based" medicine I am a bigger fan of practice-based evidence.
Remember the quote by Upton Sinclair...
“It is difficult to get a man to understand something, when his salary depends upon his not understanding it!”
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