9.14.2009

Health and Gov'mint
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Watching the reaction of the special session of the House and Senate last week with respect to healthcare reform was somewhat tortuous.

Despite all the good intentions - the gap between care received and the national infrastructure; including health systems, insurers, eligibility rules, and intangibles such as attitude toward things like wellness, diet, and exercise across the country - continues to grow.

Why is it that with escalating cost and specialization that the benefits of the investment are elusive, like balls of mercury slipping away between the fingers?

An interesting phenomenon which has occurred simultaneously with the run-up in expense is the explosion of knowledge available to the interested layperson. How many people have faced illness amongst family and friends, learned about the basic condition from the specialist - then researched the condition ad nauseum on the Internet and so became equipped to interrogate the specialist on a return visit, citing the latest journal articles which the burdened physician may not have had the time to read yet. Some professionals enjoy the challenge (when they have the time to spend with the patient) while others do not appreciate being second-guessed or called out.

On the one hand, the system as a totality is close to the breaking point; on the other hand, the ability of the individual to compile background information on the topic continues to grow. A potential solution is to see the knowledge repository as the first line of medical information, able to provide self-help. Layers of information experts or agents could provide a second line of intervention and simple diagnostics, deferring other cases to a third layer staffed by humans equipped with tools to investigate the individual's case. A fourth layer of specialists focusing on specific conditions could exist anywhere in the world and perform laboratory diagnostics; a fifth layer of experts could exist locally and provide surgical services to individuals in a given region, linked to recovery services. The structure would resemble a pyramidal hierarchy of need, mitigated by technology, and of course individuals and the experts both would have access to their personal electronic records. In terms of cost-management, individuals could earn points or credits by using the automated information systems (which could be free) and spend the credits when they needed to see an expert. In this way, individuals could be incented to manage their own health and maintain wellness, which would act as a deterrent to illness, without paying for insurance and then being spammed by insurers to discourage use of the services already paid for.

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