Game changers we need in the health system

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Jennifer Doggett

Jennifer Doggett is a Fellow of the Centre for Policy Development, a moderator of the health blog Croakey and a consultant working in the health sector for a number of professional, industry and consumer groups. She is the author of “A New Approach to Primary Care for Australia” and “Out-of-pocket: rethinking co-payments in the health system.” She is a contributing author of the books “More than luck: ideas Australia needs now”, “Pushing our luck: ideas for Australian progress” and “Creating and Implementing Public Policy”.

This is a guest blog from Jennifer Doggett, an author, a Fellow of the Centre for Policy Development, a moderator of the health blog Croakey and a consultant working in the health sector for a number of professional, industry and consumer groups.

Most of us probably can’t remember the last time we walked into a bank to withdraw money, looked up a phone book to find a telephone number or wrote a letter to a friend overseas.

Many areas of life have changed radically in the last generation due to the opportunities provided by new technologies and other societal changes. We no longer have to queue at banks, spend our life savings to make an overseas phone call, rush to the supermarket before it closes at 5pm or choose between the meagre entertainment offerings on five TV channels.

However, during this period of rapid transformation in many consumer sectors, our experience of health care has changed surprisingly little.

Yes, there are more sophisticated diagnostic machines, improved surgical techniques and more effective medicine, but the fundamental way in which health care is provided is virtually the same as it was a generation ago.

In fact it’s hard to imagine any other area of life which has been so little impacted upon by the advent of computers, the growth of information technology, globalisation and other world changing developments.

Of course health care differs in many important ways from education, entertainment, financial services and it is impossible simply to transfer advances in these fields into the health system without question.

However, I believe there are important lessons we can learn from consumer developments in other fields that could be applied to health care in a way that would be a game changer for our health system, for example:

Ebay

From Ebay we have learnt the value and power of consumer feedback. Ebay’s currency is the trust consumers have in providers generated by an active and transparent feedback system. Consumers take notice and value other consumers’ assessment of quality and providers rely on the trust and reliability comes from multiple positive consumer reports. While consumer feedback is being used in many areas of the health system, its applications are often limited, particularly in relation to provider behaviour.

There is much we can learn from Ebay about how consumer feedback can be a significant driver of change.

Amazon

Amazon is a master of maximising the consumer experience. Almost everything Amazon sells can be purchased elsewhere but its success rests on making the shopping experience as convenient and enjoyable as possible. From ‘one click’ ordering, next day delivery, suggestions based on previous consumer sales, reviews from other consumers, personalised messages about sales and discounts in areas of individual consumer interest, Amazon works hard to ensure consumers get the most out of their shopping experience. How different would our health system be if the focus was on making the experience of health care as convenient, personalised and satisfying as possible?

IKEA

The homewares behemoth Ikea has shown us that average consumers are capable of undertaking significant components of otherwise complex tasks when they are provided with standardised systems, clear instructions and accessible online support. This has re-cast the role of professionals, focussing their efforts on setting up the required systems and monitoring the outcomes while consumers take on much of the hands-on work. This learning has many implications for the health system as new technologies are increasingly providing the opportunity to deliver health care outside of traditional hospital settings. It is particularly relevant for consumers in rural and regional areas without easy access to ‘bricks and mortar’ services and for consumers who prefer to receive care at home where possible.

Credit cards

In a world where it is possible to travel to multiple countries over a period of weeks and months and still come home to one consolidated credit card bill, with the option of making regular predictable payments, it seems unbelievable that a one night stay in hospital typically results in multiple, uncoordinated bills from a variety of different providers. Even within our fragmented health system, it should be possible to ensure consumers receive simple, regular and manageable bills for the out-of-pocket expenses associated with health care. Being sick or injured is stressful and time-consuming enough without the additional effort required to manage the cumbersome way in which we manage health care transactions.

Uber

From Uber we have learnt that professional monopolies do not always result in better quality or safer services. In fact, monopolies often work to protect provider interests rather than to benefit consumers. This insight should lead us to question the role of professional boundaries and monopolies across the spectrum of the health system. For example, we should look for areas in which we could relax the current restrictions on the provision of health care in order to increase accessibility, without reducing the quality and safety of care. Also relevant is the role that consumers can play in limiting monopolies in the health system where they do not serve consumer interests.

Australia’s health system has many strengths but we all know that it will need to change if it is to meet the health care challenges of the future. One fundamental change that I believe is necessary is to move from a system driven by providers and funders to one which is oriented around consumers.

These few examples provide some ideas for how our health system can learn from other sectors which have successfully evolved to improve the quality and efficiency of the service they provide.

It may seem counterintuitive, but perhaps we need to step outside of the health system in order to find the ‘game changers’ necessary to transform the future of health care.

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