About five years ago I heard a fascinating talk by Harvard Business School Professor Clay Christensen that applied his well-know “innovator’s dilemma” reasoning to health care. In a nutshell the idea was that tertiary care centers should keep pushing the envelope on complex diagnoses and treatments and that over time diagnoses (though maybe not treatments) that had initially been considered complex and challenging should be systematized and therefore able to be carried out in less expensive settings by less expensive staff. The progression would go from academic medical center to community hospital to doctor’s office to retail clinic.
Clay was interviewed recently by the New York Times where he covered this ground again –lamenting the lack of progress- and also gave a clue as to why there is a shortage of convenient, low-cost diagnostic settings in Massachusetts.
We havenâ€™t moved the health care profession into a world where nurses can provide diagnosis and care. Regulation is keeping the treatment in expensive hospitals when in fact much lower cost-delivery models are available…
In Massachusetts, nurses cannot write prescriptions. But in Minnesota, nurse practitioners can. So there has emerged in Minnesota a clinic called the MinuteClinic. These clinics operate in Target stores and CVS drugstores. They are staffed only by nurse practitioners. Thereâ€™s a big sign on the door that says, â€œWe treat these 16 rules-based disorders.â€ They include strep throat, pink eye, urinary tract infection, earaches and sinus infections.
These are things for which very unambiguous, â€œgo, no-goâ€ tests exist. Youâ€™re in and out in 15 minutes or itâ€™s free, and itâ€™s a $39 flat fee. These things are just booming because high-quality health care at that level is defined by convenience and accessibility. Thatâ€™s a commoditization of the expertise. To have those same disorders treated in Massachusetts, youâ€™ve got to go to a regular doctor, go through a long wait in their office, you go in and see the doctor for two minutes. He says, â€œYou have an earache,â€ which you knew already, and then they charge you $150.
The whole interview is worth a read if you have the time.