Consumer-focused Care spoke with Kenneth Mays, Marketing Director for Bumrungrad International, a leading player in medical travel/ medical tourism in Southeast Asia, as a world class, JCAHO accredited (the American hospital accrediting organization) facility.
The interview took place at the World Health Care Congress and both a podcast and a transcript lay out the conversation below.
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Service has largely been squeezed out of care provided by 3rd party payor medical systems: Rationing and long waits are expected in nationalized systems from Europe to Canada; hour-long waits are common in US primary care and emergency rooms as well. People even wait to get coverage before dealing with chronic health conditions. Until service quality is so bad that people stop showing up (and switch payers), there was no incentive for a third party to pay for its users convenience/ experience.
Recently, that trend appears to be reversing, through innovation occurring in the US and the privatization of the NHS system. It is interesting to look at the similarities and differences of the two major starting points in the US system: boutique care and retail clinics.
Boutique care/concierge medicine
A membership model has started to emerge, led by groups like MDVIP. Equated to a country club, there is a steep price to get in–which buys you access to additional services and fewer people in line. There is significant variation in services that come with the subscription, but they generally include reduced wait times, increased communication options (cellphone, beeper, email) and more time to speak with the physician. Tests and other normal procedural pieces of medicine are generally billed to an insurance company, although there are practices that only take cash. Because of its primary care focus, this model hasn’t spread to specialists. However, recent innovators do seem to be taking the model downstream to the average individual (thanks to Kevin MD and The Medical Quack for the link), in a stripped down, no-frills approach approach that seems reminiscent of Costco. The Qliance model seems like one mechanism where better service may become available to the masses.
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John Goodman makes a very interesting argument pointing to 3rd party payment as a primary cause of the lack of innovation in health services. He highlights a lack of incentive for more efficient care, as it is combined more often with financial penalty instead of reward.
“There is no systematic reward for excellence and no penalty for mediocrity. As a result, excellence tends to be the result of the energy and enthusiasm of a few individuals, who usually receive no financial reward for their efforts.”
However, Goodman takes two aspects: price and quality too far. In citing the retail clinic, he claims that transparent pricing and quality of service allows success outside of 3rd party payment.
However, in discussions with Linda Hall Whitman, former CEO of MinuteClinic, this example falls somewhat short. 3rd party payment was a key to the financial viability of the MinuteClinic, including significant funds from BCBS MN. MinuteClinic’s success was based instead on SUPERIOR service combined with SUPERIOR quality at half the price.
There appears to be three approaches that consumer-focused innovation can improve upon to drive real adoption: 1) Out-of-pocket price, 2) Expected quality of care, 3) Expected level of service.
