The massive controversy over caffeine levels of decaf reported in the NYTimes Well blog highlight that people can have massively different perspectives about the value of the same product, which is what makes economics so fascinating, and top-down regulation so hard.
The Well blog got a java jolt this week as nearly 300 readers debated the merits of decaf, caffeine and espresso. The coffee smackdown was prompted by my post highlighting a Consumer Reports article about decaffeinated coffee. The CR coffee sleuths found relatively high levels of caffeine in several cups of decaf sold by popular chains.
Decaf drinkers were grateful for the information, noting that stealth caffeine is cause for concern for people who are prone to migraines or other health problems.
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As we go down the path to consumerism, its important to remember that when we put consumers in control, we don’t have top-down control over what goes on to be successful. In an environment where Furby is wildly popular one year (selling at 10X multiples of the retail price), and neglected the next, rating it against clinical studies of childhood satisfaction seem wildly irrelevant.
The thought was triggered as I was reading the NYTimes article on sleep drugs. The title was: Sleep drugs found only mildly effective, but wildly popular.
American consumers spend $4.5 billion a year for sleep medications. Their popularity may lie in a mystery that confounds researchers. Many people who take them think they work far better than laboratory measurements show they do.
The analysis said that viewed as a group, the pills reduced the average time to go to sleep 12.8 minutes compared with fake pills, and increased total sleep time 11.4 minutes. The drug makers point to individual studies with better results.
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As the new interim head of Google Health, Marissa Mayer makes an interesting statement about how Google Health will engage physicians (via World Health Care Blog) (emphasis mine)
While the focus will be on improving health care and making records more accessible and portable for patients, Google will also improve life for physicians, Mayer noted.
“The goal for a lot of doctors is how many patients can they see in a day,” Mayer said. “That means their minutes per patient has got to go down, and the less time they have to spend finding and going over patient records the better. Ultimately we will design a product that’s useful for users, and also helps doctors do their job more quickly and more efficiently.”
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Posted by
Vijay Goel, M.D. |
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Saw an interesting experience highlighting how consumers see doctors– and what they make decisions based on. Strangely enough, its not necessarily about lowest price or best technical quality…from a blog post called A Tale of Two doctors:
We recently found ourselves in need of a “primary care physician” for my husband (he was very sick). Not familiar with the doctors in this area, I asked a good friend for a recommendation. Here is what happened:
Doctor #1: I spent 20 minutes on hold with this doctor’s office before I ever reached a live person. The lady who answered the phone was fairly abrupt and matter-of-fact with me. As we are considered “new patients”, I was told my husband would have to take a 30-minute “new patient” appointment (as opposed to a simple office visit); could he also show up 30 minutes early to do paperwork? At this point, the lady checked the appointment schedule – and informed me the doctor was fully booked for 2 days! She referred me to the local urgent care clinic. I thanked her and hung up.
Doctor #2:I found this doctor’s office online. I spent about 3 minutes on hold before I was connected to a very pleasant lady. She was friendly and sympathetic, acknowledging my husband’s illness right away. She quickly found an appointment for him to come in a few hours later (a regular office visit), with a request that he come 15 minutes early for paperwork. Relieved, my husband saw this doctor.
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Dr. Rich Fogoros sent me a copy of his latest work,
Fixing American Healthcare: Wonkonians, Gekkonians, and the Grand Unification Theory of Healthcare
Its a book I highly recommend anyone interested in the system to read–and it takes more of a sociological/ historical approach reminiscent of the best parts of Demanding Medical Excellence
and The Social Transformation of American Medicine
. Where Porter’s Redefining Health Care
and Herzlinger’s Who Killed HealthCare?
highlight what a more consumer-focused system might look like and why the current system is a mess, Dr. Rich gives us a very clear understanding of why the current players have very little incentive to make that consumer-centered dream a reality.
At the heart of his argument is the Grand Unification theory of Healthcare. It is represented by a deceptively simple 2×2 matrix (seen to left) presenting decision-maker against decision quality. Dr. Rich’s assertion is that we are currently in the realm of Low quality, individually-driven decisions (Quadrant IV). Making decisions more standardized by creating better efficiency through centralized decision-making would bring us to Quadrant III– which still doesn’t take us very far, as the decisions made by the centralized power would be of extremely low quality and limited by a centralized budget– creating a situation where covert rationing is the only way to keep the budgets in check.
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You couldn’t paint a different picture for primary care providers than what is happening to colleagues on the dental side of the business (see NYTimes article). Trained better on the business front, the dental picture is evolving significantly different than for primary care– fees are rising, work hours are declining, and competition is decreasing as practicing dentist levels are flat despite an increasing population.
Dental fees have risen much faster than inflation. In real dollars, the cost of the average dental procedure rose 25 percent from 1996 to 2004. The average American adult patient now spends roughly $600 annually on dental care, with insurance picking up about half the tab.
Dentists’ incomes have grown faster than that of the typical American and the incomes of medical doctors. Formerly poor relations to physicians, American dentists in general practice made an average salary of $185,000 in 2004, the most recent data available. That figure is similar to what non-specialist doctors make, but dentists work far fewer hours. Dental surgeons and orthodontists average more than $300,000 annually.
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As I think about a consumer-focused health world where consumers are truly at the center of their health experience, I see a strong need for information to help them make decisions.
That infrastructure doesn’t yet exist today, and the PHR as an aggregator of data, such as Microsoft’s newly released HealthVault won’t change that. You’re not going to see a critical mass of people go through the trouble of assembling their medical records online, unless they think its going to do something for them. In that sense, it is somewhat comforting that the backers of HealthVault have deep pockets, as it will be a while before consumers move to this platform. What’s missing? The killer app.
In the PC wars, IBM compatible PCs became a standard, not because DOS was better than Apple’s operating system (it wasn’t) but because Lotus 1-2-3’s spreadsheet ran better than the VisiCalc spreadsheet on the Apple II– propelling IBM sales in the crucial business sector.
Until that killer app rises, with incentives aligned with purchasing parties, we’ll see adoption stay at the level of the current Electronic Medical Records systems– nice, but not yet Crossing the Chasm
over into the mainstream.
Fortunately, as mentioned by RWJF’s Lygeia Ricciardi, the business models of software companies work well with the creation of a platform that creates common data and standards.
Data contained in repositories such as HealthVault’s can form the bases of powerful tools that help individuals make good choices about health behaviors.
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There are a lot of numbers and a lot of theories floating around about why the US healthcare system is as screwed up as it is. The fact is that we today spend around $2 trillion dollars on health in the US, and anyone wanting to really do something about it needs a starting point that encompasses where all that money actually goes.
This McKinsey Global Institute report, called “Accounting for the Cost of Healthcare in the US” is a great first step in that direction. (Disclosure: I am an alumni of McKinsey & Co, but was not involved in preparing this report)
They used a robust framework to analyze the drivers of the cost of US healthcare spend:
This report by the McKinsey Global Institute outlines the present distribution of costs in the US system, and highlights where the spend deviates from a metric called ESAW–Estimated Spending According to Wealth, calculated from 13 OECD countries.
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The NYTimes has a new wellness blog, by Tara Parker Pope (of the WSJ). It has an interesting title to the latest article, called “And now, the Exercise-Resistant dieter“.
This is another instance where scientific terms such as “not statistically significant” really throw normal people for a loop (see statistical power)–and create implications that take people away from simple conclusions, in this case, that people prescribed exercise who don’t lose weight often eat more (and balance out the increased exercise with less activity elsewhere in their life).
Its really hard to get statistically significant evidence with a small trial. If you take away the statistical mumbo-jumbo, on average, the people who lost weight (when prescribed a 500 calorie exercise regimen) ate 400 less calories a day than those who didn’t, increased intake of 270 calories for those who gained weight, and decreased intake of 130 in those who lost weight. Given that initially starting an exercise program can cause initial increases in lean weight from energy getting stored in the muscle, this is a pretty easy dietary change which combined with exercise leads to weight loss.
Here’s her take (emphasis mine):
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I had the chance to sit down at the National Consumer-Driven Healthcare Summit with Dan Spirek, Chief Solutions Officer for Trizetto. As a vendor for multiple types of payors across geographies spanning the US, Trizetto has an interesting perspective in what the market will look like 3-5 years hence, as they have to look across the marketplace and build these solutions today.
- 0:00 Introduction
- 1:30 What payors are asking for
- 2:30 Moving toward greater consumer involvement (not driven by consumers)
- 3:23 What consumers are asking for–convenience and lower price
- 7:25 How consumerism (vs. CDHP) unfolds–5% CDHP penetration but other 95% still impacted
- 11:40 Closing thoughts: making consumerism work
Interview (streaming)
DOWNLOAD MP4 (ITunes) VERSION (12MB)
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