Thoughts on dramatically improving the health system

Andrew Atkin:

Competition is not about creating winners and losers. It's about driving innovation and raising standards. 

Probably the best thing to focus on is of course poor health prevention. 

The ultimate success of an idealised health system would be for it to no longer be needed. We can move a lot further in that direction.

This comes back to the basics. We should be making sure people can live well without undue stress, and a key part of this is making sure the cost of healthy living is not too high. Also important is focusing on good childcare, and minimising child abuse and neglect as much as we practically can (Traumatic childhood stress gets internalised and leads to health problems later. In fact early abuse may be the No.1 toxin our health system exists to accommodate, other than nasty accidents and old age. Good video here).

Diagnosis.

Another focus should be early diagnosis. Obviously the sooner a condition is recognised the easier it is to deal with. Respecting that nearly all diagnosis begins with self-diagnosis (you go to the doctor because you first know something is wrong), it makes sense to work with and expand on the process...

An idea is to develop systems that facilitate better (easier) self-diagnosis. For example, if someone is worried that their mole might be cancerous, then rather than waiting to be worried about it enough to bother to see a doctor, the individual could instead quickly take a photo on their cellphone and upload it for analysis, to be seen by a specialist who reviews these things. The specialist can then make the call as to whether another professional should look further, or when.

(Note, through the online process we can greatly concentrate the productivity of otherwise very expensive health professionals, as those professionals can spend less time mucking about with communication inefficiencies, and less time doing low-level work that can then instantly be delegated to others).

Developing quick, user-friendly self-diagnosis facilities could be an important focus. With modern smartphones a well-developed app could be extremely useful for preliminary diagnosis, and save a lot of unnecessary grief.

Information and health records.

New Zealand should have everyone's health records uploaded into the cloud, accessible by any professional once given the patients authority to access it.

My recently deceased father, for example, had difficulties getting the health information that he obtained from Hastings hospital transferred over to Wellington hospital, which created silly delays and costs. We need to standardise health information into master cloud files, and I must say it's surprising that this (obvious) modernisation has not already been done.

Another advantage of having everyone's health records in a standardised format is research. We can quickly search database's to identify correlations, to help us recognise where causes of health problems are (or might be) coming from. Correlations are not causes of course, but they can certainly give us good clues.

Further, it allows access to expert second-opinions, for accurate diagnosis to be efficiently conducted. This is very important. GP's don't know everything and make errors with diagnosis and treatment all the time. Giving them an online back-up review option, that's rapid and efficient, would probably be invaluable.

Improving quality and reducing costs:

Is it really necessary for a specialist doctor to spend 10 years in university to diagnose and deal with your skin condition? Of course it isn't. Most of what they have studied will be redundant to that end. Yet we pay big money to these professionals, and because only those with a vast medical education are allowed to do the job - due to the licensing system.

Is there a better way? I believe so. One model is to move to a system of fully private hospitals that are directly market-accountable...

Think of this. You go to a private hospital to deal with your condition, and after your experience you make a report on the service. The government manages the surveys. You click on rankings (1 to 10) and make comments. This record then gets pooled into the statistics that allows the public to see median rankings and patient recommendations, for any given service provider. Giving the public direct and explicit transparency.

Depending on their relative rankings, different hospitals will be able to charge different rates. Hence, you've created the commercial incentive for hospitals to improve their services to maximise their bottomline. In a sector where there's so much room for innovation, this is surely a good idea.

The transparent competitive market is a powerful natural regulator. The market could, in turn, largely replace government regulation. The new regime can be: "You can do whatever you want, however which way you want, but you will be commercially accountable for your results".

Hospitals can then also be responsible for training their own staff. We can abandon the licensing system which helps to make health services unnecessarily expensive. For example, if a hospital thinks they can train a young woman on skin cancer diagnosis in 6 months, and without having her go to university, then we can let them do it and let them save themselves (and the nation) a small fortune. Remember the hospitals will be careful not to fail. The last thing they will want is bad patient reports reducing what they can charge.

Funding:

I think the ideal is for the government to subsidise funding, to cover the most basic costs. Fundamentally it should be an insurance system.

If you want to be served by a hospital with a higher ranking, then that will be more expensive and you will have the opportunity to pay an extra premium for that access.

No hospital should be allowed to drop below a certain level in terms of ranking and be allowed to operate. There should be a minimum national standard.

Also, it should be a 'self-abuser pays' system. If you badly disregard your health and become higher-risk, then you should be expected to pay that risk-difference. These payments should be compulsory for all citizens.

Conclusion:

I believe that the final result of these initiatives would be a smaller health sector and a healthier society. Providing increased life expectancy and increased quality of life. And we should see a health sector where everyone is properly covered.

In good time, due to the virtues of innovation and well-functioning markets, even the worst service providers of tomorrow would quickly become better than our best providers today.

-Note: 03-09-2019:

It would probably be a good idea to separate the service of diagnosis from treatment, as much as practicable. Naturally, you would not want over-diagnosis being incentivised to the end of selling an expensive treatment. Also, you would not want preventative treatment being under-represented to that end either.

A close focus on incentive-mechanics is very important.