Monday, June 26, 2006

Hope for Health Care

It's finally happening, and I didn't even realize it. I came across this article on wellness centers at retail stores and pharmacies. This could be huge, and I don't know how I missed it. Health care has needed this kind of innovation for so long it's not even funny. But wait, it gets even better.

The last paragraph in the article mentions that one of the companies that is operating these clinics is using software to generate a recommended diagnosis that a nurse practitioner either approves or overrides. I've been waiting for this to happen for at least six years now. I became convinced that this is what health care needs six years ago when I was sharing a pizza with some friends at Zach's in Berkeley. One of the guys there, Joe, was a recent med school graduate doing his residency at UCSF. He was complaining about the incredibly long hours he had to work, and how zombie like it made him. I commented that it was not encouraging to know that when you see a doctor at a hospital, there is a pretty good chance they are in zombie mode at the end of an eighteen-hour shift. He told me not to worry, that 99% of what he did, "a monkey could do" and that a zombie mode doctor was perfectly effective.

Now of course any fan of Star Wars has had to wish for a medical droid while waiting in a hospital ER. So the idea of replacing doctors with technology (computers generally smell better than monkies) is hardly new. But the medical droids always seemed like such advanced technology. They seemed as fantastic as lightsabers and hyper-drives, and definitely a lot more advanced than a monkey. But that all comes from the myth that what doctors do is so hard. The truth is that what some doctors do is incredibly difficult, but the bulk of what they do is mundane. Not only mundane, but perfectly well suited for technology. Matching symptons to afflictions and making a diagnostic is exactly the kind of logic that a computer excels at.

Anyways, all this reminds of me of several great articles I've read over the years on how to fix the health care industry. First off the problems of health care come from licensure and the barriers to entry that it creates. This was spelled out by Milton Friedman's quintessential Free To Choose:

One effect of restricting entry into occupations through
licensure is to create new disciplines: in medicine, osteopathy and
chiropractic are examples. Each of these, in turn, has resorted to
licensure to try to restrict its numbers. The AMA has engaged in
extensive litigation charging chiropractors and osteopaths with the
unlicensed practice of medicine, in an attempt to restrict them to as
narrow an area as possible. Chiropractors and osteopaths in turn charge
other practitioners with the unlicensed practice of chiropractic and

This is still a big problem, as these new wellness centers are still restricted in what they can offer and have to partner with MDs on some cases. These barriers to entry make it difficult for disruptive technologies to lead to innovation and cheaper health care. The software mentioned in the article could be viewed as a potential disruptive technology. As such, I would expect the AMA come after it in a big way.

How Medical Boards Nationalized Health Care
Will Disruptive Innovations Cure Health Care?

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