The Institute of Medicine just issued a new report entitled "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America." The conclusions of the report are nicely summarized in this graphic. In short, what they say is that the health care industry should simply do what every other industry in America does, and has been doing, for years -- emphasize customer service, provide high quality, be efficient, be safe, have workers cooperate and communicate, and innovate in order to improve in all of these areas.
Really? Shouldn't all of this be totally obvious? The fact that (apparently) it's necessary to point these things out epitomizes for me what's wrong with US health care. In what other industry would businesses be closed when customers most need them (how many pediatrician offices are open nights and weekends)? In what other industry would receptionists ask for payment before greeting you or asking any other questions about what you're there for? In what other industry would customers be kept waiting for long periods of time until it's convenient for the business to serve them? What other industries actively resist the adoption of technologies that would improve the quality of the product and reduce costs (can you say health information technology)? How many customers would a bank, McDonald's, even an airline, have if they behaved this way?
The health care industry is inefficient and very reified. There are many causes behind this problem, but to my mind one of the key ones is lack of competition. Doctors, hospitals, etc. aren't efficient, and don't serve customers well because they don't have to. The reason for that is there aren't enough rivals competing aggressively enough to force them to innovate.
Health care providers have been given a free rein for many years. Perhaps the understanding (or hope) was that they'd provide high quality care for middle and upper income folks and charity care for low income people. If so, neither of those has happened to the extent it should if we are to tolerate the inefficiency, high costs, and low quality in the system. It's time for a change. More on that in future posts.