How Free Should The Medical Market Be?
New post up at Homeland Stupidity:
The American Medical Association has been proposing one protectionist or statist piece of legislation after the next, and while their motives are just as impure as ever when it comes to challenging the growth of retail-store healthcare services, as Dr. Thomas Davis points out, these retail-chain clinics aren’t the free market supporter’s wet dream that some would have us believe.
The basic point is much the same one I used in my critique of market anarchy. In this case, the big sticking point when it comes to a completely free medical market is perfect information. Or more specifically the lack thereof. I can’t think of any other market quite so large where consumers understand so little about the products and services they purchase. It’s not a matter of elitism, just a recognition that medicine is a highly complex field requiring a lot of specialized knowledge. And it definitely isn’t a function of intelligence *cough*.
My biggest proof of this? The fact that chiropractors remain highly regarded, no matter how far into quackery they descend. I’ll admit that due to sampling bias, I only hear the worst stuff. I hear the nonsense about how a bent spine can cause heart arrythmias. And, as a couple of spinal surgeons I’ve known have said: “I love chiropractors. Without their former patients, I wouldn’t own that home in Europe”. And I know the truth about their less-than-scientific education. They are just one example though, big pharma’s manipulation of both consumer and doctor ignorance being a much bigger instance of imperfect information.
I think that licensing and credentials have a vital role to fulfill, one that can only be strengthened by competition. If such agencies competed to field higher quality doctors and practitioners, the result would be that simply by looking at a doctor’s brand you would have a good proxy for his quality. Likewise, I think competition would stimulate a more effective symbiosis between NP/PA’s and doctors. Currently they operate quite antagonistically, with NP’s and PA’s seen as a threat to the primary care doctor’s practice. Sometimes you don’t need the 11 years of training and education a PCP has, but then again sometimes you do. If you could go to one place–and make one appointment–for both, everyone wins. And I think a more free marketplace would allow clinical PharmD’s to assume a role more commensurate with their education (they know a lot more than they’re given credit for).
Choice is important, and I think that opening up the marketplace can only be a good thing. Just don’t throw the baby out with the bathwater.
Nik:
Interesting post; insofar as healthcare is in the midst of converting to an electronic health record, I wonder how much this part-administrative boon/part-”decision support” tool will benefit patients and healers of various responsibilities (a distinction you made in an earlier post that’s stuck with me). The most obvious and quantitative metric is the improved efficiency: more patients per day, more safety and probably fewer mistakes on the part of said healers. Bedside manner can be impacted a bit by a Dell workstation serving as a node between patient and provider. But its a “disruptive technology” and stands to change things that only sci-fi authors can anticipate - and I don’t know whose written about healthcare IT…
In medical school, are they training you to interface directly with computers instead of paper charts? What do they tell you about the EMR/EHR? Is that something you learn once you’re in an individual practice?
The technology as is reminds me of AOL circa mid ’90s: unimaginative but functional - a digitial calcification of standard meatspace procedures. But perhaps it won’t be long before “killer apps” and obnoxious techy terminology begin to complement healthcare; and to your point about competition: I think the most obvious next stop on the healthcare IT roadmap is Pay for Performance, which will probably add a commodity like “information” or something like that to the tenets of quality, access and cost. Quantifiable metrics will change the way those chiropracters present themselves; the anecdotes that shadily testify to any practice’s efficacy will seem like “1000 hrs of Free AOL” CD’s in the mail - and patients won’t need to know all the complicated fancy stuff you’re learning cuz there will be an easily readable index of sorts - underpinned by said fancy and complicated stuff - that informs them better. And I think thats pretty cool. And hopefully so will patients; it will be interesting to map out how stark the disparities are. Expect a few heartfelt NPR stories about that new “social issue”….
Apparently healthcare can be pretty moribund when it comes to innovation; the word on the street is that if it doesnt directly save lives, it’s hard to advocate for and impossible to implement. Maybe P4P metrics will spook participants into creating a more efficient “market” functionality - whether that means more patients finding better doctors or OK doctors upping their ante to become great doctors.
On the other hand, maybe it just means more patients per day and some databases to mine while getting an advanced degree or something. But bringing medicine into this side of the digital divide is an exciting prospect. Any thoughts?
Comment by Phil — June 27, 2006 @ 10:04 am
The AMA will use it’s bulging coffers to defeat any effort to get ‘perfect information’ to patients. It is not just bureaucrats and service sector employees that are to paraphrase Homer Simpson ’surly and lazy’, highly educated medical professionals also perform poorly with ‘Impunity.’ I can’t see Doctors breaking ranks and allowig information to be readily available to patients.
Comment by intellectimpure — June 27, 2006 @ 11:18 am
Intellectimpure:
It may not be the doctor’s choice. Some doctors will disclose information as a means of promoting their “brand,” as Nikhil called it. Some inertia is always amidst organizational change, but it will not be the defining feature for very long, no? However, patient behavior may be different than how people behave in other markets that lack the imperatives and existential factors in healthcare.
But maybe I’m misreading the “ranks” you speak of; if they (doctors) behave as a bloc of monolithic consensus - something comparable to a teacher’s union, for instance, then maybe what you say will be what happens. But there are incentives for good practices to produce some manipulation of their numbers; less so for less effective practices.
Forgetting the participation of the providers, it may be entirely patient-driven; perhaps patients will have to sign NDA’s as well as HIPPAA to keep such information under wraps; but if the AMA decides to behave like the RIAA in this regard, I’d suspect there’d be more force acting upon it than hipsters and geeks.
Comment by Phil — June 27, 2006 @ 12:16 pm
Phil, your first comment’s wayyy too long to address while i’m supposed to be working hard in my cubicle. I’ll get to it in a couple days tho i hope, lot of good points in it.
as for the AMA, they’re on the downswing. Even doctors are fed up with their political posturing and idiotic protectionism. A de-facto union is only a good thing if you’re not a particularly talented member of said profession.
AMA membership is slipping. AAPS membership on the other hand is going up.
AMA starts an anti-gun group, the AAPS starts a pro-gun group. AMA says something stupid statist and protectionist. AAPS counters.
It’s kinda cute.
You can guess which one I’m a member of.
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