Six Forces That Can Drive Innovation—Or Kill It
Players
The friends and foes lurking in the health care system that can destroy or bolster an innovation’s chance of success.
Funding
The processes for generating revenue and acquiring capital, both of which differ from those in most other industries.
Policy
The regulations that pervade the industry, because incompetent or fraudulent suppliers can do irreversible human damage.
Technology
The foundation for advances in treatment and for innovations that can make health care delivery more efficient and convenient.
Customers
The increasingly engaged consumers of health care, for whom the passive term “patient” seems outdated.
Accountability
The demand from vigilant consumers and cost-pressured payers that innovative health care products be not only safe and effective but also cost-effective relative to competing products.
Prescriptions for Public Policy
In the United States, a few policy changes would jump-start the health care industry’s ability to innovate.
Universal coverage.
Ensuring that the 46 million or so uninsured people in the U.S. have health insurance would spur innovation by dramatically increasing the size of the market. But is it achievable? Universal coverage is, after all, one of the most contentious political issues of our time. Switzerland offers some possible answers. The country requires people to buy health insurance, subsidizing the sick and those who can’t afford coverage. Although the Swiss government constrains the design of benefits, Swiss insurers have greater incentives to respond to consumer needs than do U.S. insurers, which sell primarily to employers or to government-based organizations. Switzerland’s excellent health care system costs only 11% of GDP, versus 16% for the United States. More detail on the Swiss experience can be found in an article I coauthored, “Consumer-Driven Health Care: Lessons from Switzerland” (Journal of the American Medical Association, September 8, 2004).
A consumer-driven system.
Giving U.S. consumers control over their health insurance spending would transform the health insurance market, better aligning consumers’ and innovators’ interests. We are already seeing this in the case of the increasingly popular low-cost, high-deductible health insurance policies offered by many employers. To create a completely consumer-driven system, we’d need to replace tax laws favoring employer-based insurance with individual tax credits for health insurance spending, thereby prompting the transfer of funds that employers currently spend on employee health insurance to the employees themselves.
Market-based pricing.
A system in which insurers set the prices that providers charge consumers is inefficient and a barrier to innovative attempts to integrate health care activities. Think of Duke University Medical Center’s innovative congestive heart failure program: The problem has been that the more patients it could successfully treat without lengthy and expensive hospital admissions, the less money it would make in insurance reimbursement. Disincentives to provide lower-cost care are common; making patients healthy usually doesn’t pay. And integrating care—offering the medical equivalent of an automobile, rather than a wheel, an engine, and a chassis—typically doesn’t have a reimbursement code.
An SEC for health care.
In a consumer-driven health care market, how can you shop if you don’t know the prices or, more important, the quality of what you’re buying? The best mechanism for transparency exists in the financial markets in the form of the U.S. Securities and Exchange Commission. While it has its flaws, the SEC generally ensures that consumers have adequate information by requiring companies to publish financial results that are verified by an independent auditor. In health care, the outcome data of individual providers of care are rarely available, and, when they are, they may be of dubious integrity because they aren’t audited by certified, independent professionals.
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