ฝัง
- เผยแพร่เมื่อ 22 เม.ย. 2012
- Smart Ideas For Fixing Healthcare
New videos DAILY: bigth.ink/youtube
Join Big Think Edge for exclusive videos: bigth.ink/Edge
----------------------------------------------------------------------------------
Clayton Christensen on how public-private partnerships can fix the healthcare system.
----------------------------------------------------------------------------------
Clayton M. Christensen:
Clayton M. Christensen is a professor of business administration at the Harvard Business School. He is the bestselling author of five books, including his seminal work, The Innovator's Dilemma, which received the Global Business Book Award for the best business book of the year, and most recently, The Innovator's Prescription, which examines how to fix our healthcare system. Christensen serves on several public and privately traded boards and is the founder of a successful consulting company and an investment management firm. He holds a B.A. with highest honors in economics from Brigham Young University and an M.Phil. in applied econometrics and the economics of less-developed countries from Oxford University, where he studied as a Rhodes Scholar; he received an MBA with high distinction from the Harvard Business School in 1979, graduating as a George F. Baker Scholar, and was awarded his DBA from the Harvard Business School in 1992.
----------------------------------------------------------------------------------
TRANSCRIPT:
Topic: Healthcare Solutions: Past, Present and Future.
Clayton Christensen: About half of the healthcare that is provided in America is really unnecessary.
I’m Clayton Christensen. The Robert and Jane Cizik, Professor of business administration at the Harvard Business School.
Question: Why are healthcare costs so out of control?
Clayton Christensen: It’s difficult to measure the extent to which the healthcare cost or out of control because in some markets the prices are controlled. In the United States, where they are not, prices are increasing at 10 to 12 % per year, roughly triple the rate of inflation.
In other countries where they have a nationalized healthcare systems, you have the same sort of inflationary pressures, but a cap on costs based on the government’s budgets. As a consequence they control costs by offering less and less healthcare. But that mismatch between what healthcare costs and what people think they can afford is a plague that affects everyone in the world.
Question: What drives the cost of healthcare in the United States?
Clayton Christensen: A major driver of the cost of healthcare in the United States is a compromise that was reached with the American Medical Association in the 1960s when Medicare was first established.
In order to buy off the doctors, the government agreed to compensate doctors on a fee-for-service basis, and what that means is the more services doctors provide, the more income they make. And the more complicated and expensive the services that they provide are, the more income they make.
The fee-for-service system essentially pours gasoline on the fire of healthcare cost inflation because when we guarantee that we will reimburse them for whatever they do and whatever it costs, they are just incentivized to offer more and more and more.
Question: What are the free-market solutions?
Clayton Christensen: There is a tremendous benefit in enabling lower cost venues of care, such as homes or retail clinics with devices that enable them to do more and more sophisticated things.
For example, the cost of end-stage renal care for patients with kidney failure is enormous. At the beginning, those patients had to go to a dialysis unit in a hospital and then free standing dialysis clinics have been created. But now the ability to dialyze your blood has been transferred to the home in the form of machines that are about the size of a bread maker. And every night, patients can plug themselves into this home dialysis equipment and scrub their blood clean so that they don’t have to go to the higher cost venues of care.
Retail clinics are able to care for about 36 disorders now at very low cost and minimal inconvenience; where a nurse practitioner is able to just follow the rules of when you have a precisely diagnosable disease, what the therapy needs to be. These are high quality interactions.
When you make something simple and rules-based, you take the judgment out of the care. Whereas you would think that a retail clinic’s staffed only by a nurse practitioner would be more subject to malpractice lawsuits; it’s not the case. No retail clinic has ever yet been sued for malpractice because everything they do is rules-based and as long as you follow the rules, there’s no basis for malpractice lawsuits.
Read the full transcript at bigthink.com/videos/smart-ide...
Eloquently said. Love it! Thanks prof christensen!
He says "In countries where government controls health care the costs are controlled..." [he lowers the tone of the voice and continues...] "by offering less and less health care..."
Very insightful. Even helpful for business.
I think it makes sense to focus public spending on the early phase in the process i.e. precise diagnosis. But what about the even earlier phase - preventative healthcare? Japan has excellent healthcare, and one of its features is really rigorous and good quality preventative measures e.g. screening, so people are less likely to get seriously ill in the first place.
you fix healthcare by lowering the costs. You lower the cost by reducing the problems that cause it to be expensive. Its not rocket science. The causes are 1. Healthcare providers charging too much. 2. Health insurance costing too much. 1 is caused by 2. Healthcare providers have no incentive to lower their prices because insurance pays for everything and insurance company's have no incentive to lower their prices because they have a monopoly or near monopoly in most places and liberals want insurance to cover everything and with no limit on how much they payout for malpractice awards. Just imagine if all the gas stations in your state were owned by only 1 or 2 company's and you could only buy gas in your own state or else you had to pay a penalty of like 50%. Then the government starts requiring that the gas stations pay for free oil changes, and free scratch removal for anyone who owns a red car. Now how expensive do you thing gas would be? Of course its not a perfect parallel since people don't have to buy gas to survive and there are alternative ways to travel, not so with healthcare.
1. lower insurance prices by increasing competition between ins. company's by letting anyone buy insurance from any legally operating insurance company anywhere in the world (insurance without borders) and letting anyone negotiate any kind of policy with their insurance company they want. Competition always lowers prices.2. Lower the cost of health care by getting rid of the incentives for people to buy health insurance. Insurance should be for unplanned and unexpected medical needs and prevention. It should not cover the logical result of intended actions unless it is specifically designed for it and the person has paid extra for that coverage. If you decrease insurance coverage healthcare prices will be forced to go down. Medical practitioners should not be allowed to charge for frivolous things or charged more than the fair market price of an instrument or service unless the patient is notified ahead of time and given cheaper options. No extortion, If a medical procedure is started and later it's later determined a more expensive instrument or procedure is needed then the original price for it must be charged or offered for free. No bait and switch. Talking to a patient should not be charged as an office visit. Patients should not be charged for anything preventative that is not covered by their insurance and that they did not agree to.3. Patients should be allowed to deduct insurance premiums or medical care from their taxes up to 10% of their income. This will allow people to afford insurance and healthcare without it having an effect of the price that insurance or healthcare providers charge. If someone still cant afford it then they should be allowed to pay in installments over time for as long as it takes but they must pay for the services they agreed upon. If that can be done for a mortgage and college tuition then why not healthcare? Medical practitioners should be allowed to deduct any special services they provide for low income people from their business or personal taxes.4. Insurance and medical care should be charged based on the policy and the market. No one should be getting free or cheaper healthcare or insurance as a benefit of their job. Workers comp not withstanding.5. Get rid of any requirement by insurance company's that disputes always be handled out of court. The right to sue insurance company's for not paying for services they agree upon should be preserved. All of this is common sense.
Thank you.
Let the individual states make their own healthcare laws based on whatever is Constitutional in their state. It is not constitutional for the federal government to be involved in healthcare. If the federal government is involved then the states have no incentive to control the costs. If a state wants socialized medicine then so be it, as long as they aren't violating their state constitution and the U.S. Constitution. The people are free to leave. If a state wants a free market or mix market approach, so long as it works then great. They can be a model for the other states. People are free to live in any state they want. It is not so easy to move to another country if you don't like the way the Federal government does things.
Big Stink