Redefining Health Care: Creating Value-Based Competition on Results

Released by the Harvard Economics Professor early in 2006, Michael Porter and his coauthor Elizabeth Olmsted Teisberg attempt to argue for the need to change competitive strategies in the United States’ health care sector.

Health Policy has never been so critical. Countless scholars have attempted to suggest remedies for the country’s ailing health care system and just about everyone has failed. This book is another example of a failed attempt to show ‘what needs to be done.’ This work is by no means a blueprint for health care reform.

Neither author comes from the health care setting. Both professors are in fact scholars of economics and business strategy. Neither author has no true bearing of what it is like for patients to be in the acute care setting. For example, the text contains a contradiction as to the importance of the patient’s self-awareness and involvement in his or her care. On page 246, the authors mention that the idea that “patients can or should become medical experts and direct their own care is misguided and unrealistic.” However, on pages 298, 299, and 436, the authors point out that being an “informed” patient not only requires “greater involvement and responsibility”, but also that “patient responsibility” … “enables treatment to succeed.”

This text is truly a disappointment as it leaves out so many of the flaws in this health care system that really need to be revamped. There is no mention of the need for acute care hospitals having patients in private rooms only as opposed to dual-occupancy rooms. The growth of antibiotic-resistant strains of microbes have gotten seriously out of control necessitating the need for facilities to have single-occupancy patient rooms. There is no mention of the impact of the nursing shortage. Nurses have to fight for their wages, face heavy workloads, deal with understaffed settings, and live with an ongoing professional lack of respect. There is no mention of how unprepared hospital settings are for overcrowding or disasters. The demand for competent nursing has been so great that certifications such as pediatric advanced life support or advanced cardiac life support have been made far more easier to pass so that even ill-prepared workers may obtain such certifications. Sadly, despite the fact that individuals may want careers in nursing, clinical instructors at community colleges or universities are sorely lacking. Free market theories fail to apply to the nursing shortage dilemma because of the complexities of this broken health care market.

Another contradiction exists with regard to a lack of a health care system coordinator. On pages 51 and 296, the notion that there is “piecemeal,” “disjointed,” or “fractured ” care is evident in that “there is often no physician to help navigate the system and ensure follow through.” Yet on page 251, there is mention that nurses “specializing in the particular disease works with the patient to be sure that the information available is understood” and that on pages 247 and 250, nurse health advisers provides “outreach education to patients before and after hospitalization, guidance on health risk management, and health coaching and referral assistance” - patients are “guided through the process by a skilled nurse who not only supports the initial choice of provider but also becomes the adviser over the course of treatment.” Nursing, therefore, helps acclimate the patient into the system to coordinate care. Ideally, this is what nurses do. Not all nurses do this of course, but just like physicians, some nurses are better than others.

I would have expected more from professors of the University of Virginia and of Harvard University. The authors even misspelled and left the ‘r’ out of the word “stroke” on page 118.

I strongly disagree with the authors’ notion that consumers should not be medical experts. People in general need to know how to take care of themselves. They need to exercise, eat right, be in health relationships, and to know how to manage stress. They need to see their physicians and take whatever medications their bodies require. It is a ludicrous argument that consumers or patients know which physician or hospital has the best outcomes. Physicians and hospital workers make mistakes. And “human” mistakes in hospitals or any health care setting will never cease to exist.

Lastly, on page 359, the argument in support of specialty hospitals is a poor one. For example, far too often, patients that go sour in outpatient surgical centers need an inpatient admission into an acute care hospital. Costs increase due to the need for a facility to facility ambulance transfer as mandated by federal laws. Further, the need for staff well-versed in resuscitative methods demands hours of costly training that hospitals are forced to comply with.

This book needs to go the the fiction section of the book store. The book ignores very expensive aspects of health care such as AIDS/HIV, psychiatric care, and ambulance diversion in the midst of emergency room overcrowding. Sadly, only in “Fantasy Land” will their theoretical notions and recommendations take hold.

Rating: 1 / 5
Redefining Health Care: Creating Value-Based Competition on Results

Michael Porter presents a clear insight of the US health system which is flawed in many ways.
Rating: 5 / 5
Redefining Health Care: Creating Value-Based Competition on Results