The Airline Industry and Health Care

In many past speaking gigs, the Disease Management Care Blog used the airline industry as a template in thinking about where health care is going. Increasing automation (releasing the pilots to focus on what was important), shared responsibility (other highly trained professionals share the job of getting the plane in the air), consumerism (destination and safety are assumed, it's how soon that beverage cart gets to my seat that is really important) and transparent price competition (including user-friendly web sites) were all going to mean better travel (quality) at lower fares (cost).

Was the DMCB as prescient as it likes to think?

After reading the Weekend Financial Times article on how dreadful flying has become ("Flying Backwards", the DMCB still thinks so. The airline industry's emphasis on safety (fatalities per passenger-mile have dropped exponentially) and pricing (albeit with a perpetually lousy return on investment) have paid off for fliers. Unfortunately, customer service has clearly lagged.

Patient safety is not where it it needs to be but at least it's being measured: a good first step and it will get better. As for pricing, healthcare is operating under the Medicare fee schedule. This results in relative overpayment for some specialty services and underpayment for others (such as primary care). It's the underpayment in primary care that has led to crowded waiting rooms (like the back of the plane) and lousy customer service (delays? pfft!). Yet, the good news is that the primary care physicians are also looking at automation, shared responsibility and consumerism.

It all adds up to the Medical Home. The only difference is the pricing, which is not being left up to the market. Let's hope the Feds get the pricing right.