on 24 March 2010
Political fights over health care reform have generated countless pages of editorials, commentaries and polemics, and hundreds of hours of television and radio programming. However, the onslaught has included depressingly few carefully considered, thoughtfully presented proposals for holistic reform of the health care system. This book by Clayton M. Christensen, Jerome H. Grossman and Jason Hwang is one of a very small number to transcend agitprop and offer an intelligent way forward. Its thesis is that in the natural course of economic progress many changes will happen inevitably in the health care industry. The book explains that health care is not fundamentally dissimilar to other industries where "disruptive innovation" has brought efficiency, economy and quality. Since the health care industry is likely to follow, for example, the path of the computer industry, getAbstract suggests this book as a must-read for health care professionals, policy makers and anyone with an interest in the future of the field. Perhaps these ideas - or even the thinking provoked by disagreeing with some of them - could help shape a robust solution to a vexing global problem, if that solution survives the legislative process (evoking the old saying that you should never watch laws or sausages being made - alas, it's too late for that).
"For I know the thoughts that I think toward you, says the LORD, thoughts of peace and not of evil, to give you a future and a hope." -- Jeremiah 29:11 (NKJV)
In The Innovator's Prescription, disruptive innovation expert Professor Clayton M. Christensen teams with Jerome H. Grossman, M.D., and Jason Hwang, M.D. to consider how new technologies, improved business models, changed processes, improved regulation, and better ways of training can greatly expand the amount of health care that can be provided for what is being spent now, opportunities to speed better treatments through development and testing, and patients can be encouraged to do more for themselves. The basic arguments are based on analogies to other major industries where disruptive innovation caused costs to drop as greatly simplification and specialization occurred.
I think that few will disagree that the opportunities described here are mostly real ones. I wasn't convinced that the foundations for change are sufficiently well established to make serious shifts in the United States. I believe that what is described here is very likely to occur rather in the rapidly developing part of the emerging market countries such as India (home of Aravind Eye Care System) where the lack of any health care for many creates a humanitarian incentive to lower regulatory barriers and to push aside old, outmoded habits.
Americans don't seem to be fundamentally unhappy with their system of very expensive health care that produces results in many categories that are inferior to what is achieved in other developed countries. It's a lot like the benefits the U.S. government dispenses when it runs trillion dollar deficits. Most people are getting a lot more back than what they put in. The free lunch will have to stop before the efficiencies will begin.
I was pleased to see that unlike earlier books by Professor Christensen this one attempts to integrate business model innovation into the discussion. The result was unfortunately pretty primitive, describing four categories of business models rather than the full richness of business model innovation. I'm increasingly persuaded that the so-called disruptive innovation school is really just the study of how specialists simplify, streamline, and organize markets that poorly organized generalists are trying to milk through charging as high prices as possible. That's only one category of disruptive innovation, but it is certainly a valid one that has been very important for over 100 years.
The book's other missed opportunity is to look well beyond what today's best practices suggest . . . toward what the ideal way to foster competition to do a great deal more for less and improved health (rather than health care) would look like.
Despite those missed opportunities, I don't know of a better book for proposing some helpful ways to at least allow Americans to get more health care for what is being spent. Nice work!