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Innovation in health care

Health care is a complicated industry.  Not just because human body is complex, but also because of the complex ethical, organizational and financial setting around it.

by Reima Suomi
Professor at Turku School of Economics, University of Turku, Finland

First, health, unlike most normal commodities, has almost endless demand.   Not maybe everybody in practice, but in principle we would all like to live forever in the physical body of a 15-year teenager.  This means endless demand, and endless flow of resources to satisfy this demand.

The simple solution would be to leave health to market forces: just as you care for your car as much as you can afford, you could be made responsible for maintaining your health.   If you have no success or means for this, it is your very own fault. Obviously, this is not the way to go.

The other end of option is the public power controlled and maybe also provided health care system. This is what some Americans call “socialistic health care”.  Their naming documents the basic doubts:  publicly provided services usually tend to be substandard and expensive, because of bureaucracy and lacking competition.

The empowered  - also knowledgeable and resourceful – patient, that health care so much calls for, remains a distant dream.  This will not be the golden path to better health care.  Yes, we might have empowered citizens as it comes to health care, but usually they are not much consuming health care services.  When they become heavy users of health care services, they usually by definition are not any more empowered, but need professional and other external help.

The human body is too valuable and precious just for him/herself.   It is in the interest of many other parties too that the body remains in good condition.   Family, employer, public authorities in general, they are all interested in keeping the individual fit.  So they are interested in co-financing one’s health.   Even for the rather wealthy individual, carrying the possible costs of maximum health care needed him/her-self could turn out too burdensome.  Insurance is needed.  In total, the natural and real payers for health services are many, which opens opportunities, but also creates a financial mess.

The traditional way to answer to the demands of health care has been to add resources: more money, more devices, more medicines, more staff and medical research. As a result, health care is growing its proportional part of national economies constantly. Research has anyway already long ago shown that in health care – as in any other industry too – results are not in a direct proportion to the use of money. On the contrary, sometimes more money can mean worse results. Very few industries, not to take into account those that have begun from almost almost empty, can claim such a growth in our societies: in fact most industries diminish their share of the gross national product – take agriculture as an example: societies spend less and less resources of the total to producing food.  Why and how can the development be totally different in the case of the other basic commodity besides food – also health.

Take a look at other growth industries – yes, there are some of them.  Tourism and international civil aviation as a flagship of it has grown constantly for decades, and there is no stop in sight for the growth.  The key and central player, airlines, have not made a joint win for almost ever, but the industry keeps growing, and simultaneously undergoes deep structural and other changes. Joint points for health care and aviation are clear: Service offerings differentiate fast and strongly, public regulation on the industry remains strong, and key players do not make a big win.   In health care these key players are public hospitals.  The difference is that in aviation benefits and salary levels of many workers have gone drastically down: health care does not seem to have this phenomenon, maybe simply because in most places the basic workforce does not earn very much – of course health care also has its well-earning elites.

One great innovation path in health care is that of clinical pathways.   They should aim at standardization and best possible care.  Both goals are short of becoming reality.  Humans are not similar, and suffer from different combinations of symptoms, signs and diseases, not to speak of environmental and inherited factors.   The multitudes of payers as discussed above set different limits and conditions on their willingness to pay.   The end result is that standardized clinical pathways are next to impossible to create. Best possible care remains also usually a distant dream: it is too expensive and resource-consuming to deliver with limited resources, and especially describing these best practices in clinical pathways – implying that everyone is entitled to them – is a financial suicide for any health care provider.

The conclusions toward health care innovation tend to emerge.  Medical and care and cure innovation is and remains the cornerstone on innovation in health care, but much more should also be done in the non-medical innovation field. The whole system of delivering health and well-being services should be designed anew. Organizational, process, systemic, application, business, social and cultural innovations are as well needed in health care. Unfortunately, to work on this field, society delivers very little resources.

Another conclusion is the same as in warfare, embodied in the classical comment by Georges Clemenceau: “War is too serious a matter to entrust to military men”. Health care is so complicated and crucial industry, that its development needs also other skills than medical.   Politicians are bad designers of health care, as they are usually in power just for a short time, and their thinking tends often to be limited by vague but for them important political manifestations.   Medical staff is already nicely speaking of multiprofessional care teams, but unfortunately they mean multiple professionals inside the medical profession: outsiders are usually not welcomed to tackle with health care issues.

Health care industry tends to stick to different hypes  - as well as the computer industry.  Empowered patients, clinical pathways, multiprofessional care teams, all those are examples of innovations that are important if not even crucial.  What anyway remains is the need for more comprehensive systemic innovations in health care, that would start from studying the very basics of health and sickness, and the ethical, societal, economic and organizational settings around them.