Spring Break
Michael Porter: Overhauling Health Care
Arar Han (RA), Contributing Writer
Issue date: 2/28/05 Section: News
His assessment of the cause of rising costs was perhaps the most damning part of Porter's presentation. As Porter pointed out, "we don't know who the best provider is [nor] how much experience they have...in treating individual conditions." Because of this lack of data, he explained, competition [at the] disease level has been virtually eliminated, with competitive energy overwhelmingly directed at "micromanag[ing] process rather than foster[ing] competition on results." Legislation such as one in the pipeline in Massachusetts, cited Porter, specifies procedural technicalities such as the number of nurses per patient, while providers continue to be paid to treat, then be paid again, to "fix their mistakes."
The nature of the problem is essentially managerial, Porter determined. Hence, he claimed, the blame is rightfully on businesses, which, remained wrapped up in a "culture of denial" as early weaknesses in the health care system mounted into a full-blown crisis. "Any employer worth his salt should know that quality matters," railed Porter. Employers should know that the objective of health care is not cost, but value, he continued, and that the "massively fragmented system" of providers should be consolidated at the local level by expertise, so employees can "find the excellent provider of the services [they need]." "All of these things should be obvious to businesses," scolded Porter, "but they have been complicitous."
Although Porter painted a picture of a severely crippled system, he stopped short of calling the situation helpless, instead offering the optimistic view that "if we just had the will," reforms are "very much in reach today." To begin, he said, insurers need to begin collecting information on providers' treatment success rates by disease, rather than by pieces of diseases. Moreover, said Porter, doctors need to stop being treated as "free agents," or "journeying yeomen" in a "pre-industrial guild" and committed to groups in which they see the whole cycle of disease treatment, rather than merely taking part in their step of the assembly line before moving on to the next patient. With these two changes, Porter theorized, not only would patients have the information needed to make educated decisions about their health treatment, but genuine expertise could be developed in the successful treatment of the full run of a disease.
The nature of the problem is essentially managerial, Porter determined. Hence, he claimed, the blame is rightfully on businesses, which, remained wrapped up in a "culture of denial" as early weaknesses in the health care system mounted into a full-blown crisis. "Any employer worth his salt should know that quality matters," railed Porter. Employers should know that the objective of health care is not cost, but value, he continued, and that the "massively fragmented system" of providers should be consolidated at the local level by expertise, so employees can "find the excellent provider of the services [they need]." "All of these things should be obvious to businesses," scolded Porter, "but they have been complicitous."
Although Porter painted a picture of a severely crippled system, he stopped short of calling the situation helpless, instead offering the optimistic view that "if we just had the will," reforms are "very much in reach today." To begin, he said, insurers need to begin collecting information on providers' treatment success rates by disease, rather than by pieces of diseases. Moreover, said Porter, doctors need to stop being treated as "free agents," or "journeying yeomen" in a "pre-industrial guild" and committed to groups in which they see the whole cycle of disease treatment, rather than merely taking part in their step of the assembly line before moving on to the next patient. With these two changes, Porter theorized, not only would patients have the information needed to make educated decisions about their health treatment, but genuine expertise could be developed in the successful treatment of the full run of a disease.
