A HUGE amount – maybe as much as one-third – of writing about the crying need for health reform in the US is devoted to how much money we waste on “unnecessary” activities (curiously enough, the waste figure seems to hover around 1/3 of all health care spending, too).
We have become dismayed by these observations, which we believe are accurate enough. We’re dismayed because despite their inarguable logic, the irrefutable facts brought to bear, no one seems to be doing much of anything about it.
So we’ve concluded that we need to pretend that wasting health care resources is a good thing. Or, at very least, a mostly unavoidable thing.
I know: you’re thinking what the twitterkids type: “lol wut”
Fine, be that way – but play along with me for just a paragraph or two.
Imagine for a moment that the problem isn’t that wasting health care stuff takes place, but that we’re wasting the wrong health care stuff. How would we figure out what the “right” health care stuff to waste is?
We’ve started by thinking that it is probably not wise to waste stuff that is vital for dealing with immediate, life-threatening health events. Let’s put highly skilled, specialized medical professionals in that category of stuff: surgeons obviously, and probably a number of other types of doctors, nurses, and technical experts.
We also probably need to put many types of facilities and equipment in there, too: some types of hospitals, exquisitely tuned testing equipment, etc.
Most of this stuff we don’t want to waste shares the characteristic of being used after it’s determined that something must be done. That is, this stuff is employed once people are diagnosed with an illness or injury that needs treatment now, often specific treatment, or at very least a specific course of intensive observation.
Ok, maybe we’re getting somewhere here.
Other medical stuff – used for identifying and monitoring care – tends to be less “expensive” both in terms of its actual price AND in terms of the risk of “wasting time” on non-critical activities, where ‘wasteful’ deployment of resources may deplete our reservoir of resources for producing the “rescue care” we identified above.
Identifying and monitoring health BEFORE rescue care is needed makes a lot of sense. And our health system has never really done it all that well. We’ve kind of left that function to moms, to be done pretty unsystematically for the most part. That’s right – historically, for health care purposes, we’ve wasted moms.
Now we’re seeing the emergence of methods – technologies – to do identification and monitoring more systematically. More inexpensively. Retail clinics are one such ‘technology’ that’s configured to perform systematically, for a well-defined set of purposes, and to perform economically as well. The profusion of emerging mobile health technologies are predicated on this notion as well – it’s not that they are necessarily better ways to identify/monitor health than more conventional means, but that they are good enough, and much less expensive than conventional ways. Their use makes sense, and their occasional use in situations where they weren’t all that necessary to provide an adequate health care solution is no big loss. No big waste.
So they can, and should, be wasted.
Heresy!
We expected that. This New York Times article on health system efforts to cut down falls among elderly patients provides current example of the same kind of thinking, by people with MUCH more clinical credibility than we at Healthcare 311 have (not hard, since we don’t have clinical credibility):
….researchers are beginning to apply the digital tools of low-cost wireless sensors in carpets, clothing and rooms to monitor an older person’s walking and activity. The continuous measurement and greater precision afforded by simple computing devices, researchers say, promise to deliver new insights on risk factors and tailored prevention measures….
….“For the last 100 years, clinical research and medical practice have been based on appointments, examinations and asking patients questions — tiny biopsies of time in a person’s life,” said Dr. Jeffrey Kaye, a professor of neurology and biomedical engineering at the Oregon Health and Science University. “… technology now gives us the ability to get behavioral activity data all the time for a much more fine-grained, real-world picture of what is happening with a person’s health.”…
Opportunities for use of retail clinics can be imagined in much the same way: they provide convenient, budgetable ways to increase the fidelity of a person’s picture of their health, by permitting greater frequency of potentially useful observations.
Clinic critics love to posit a one-to-one substitution of clinic visits for visits with a higher-skilled, more “professional” clinician. And that isn’t a realistic model of how clinics can provide value. Unless we think about retail clinics’ role in terms of “what health care resources can we waste?”, we might well miss their real potential for helping make our health care system better.
*(While it doesn’t deal with health care, Wired editor Chris Anderson has written very persuasively on the “waste” concepts we’ve talked about in his book Free, excerpted here: Waste Is Good (6/22/09 Wired magazine)