Managing and Improving Healthcare
The conversation on Managing and Improving Health Care drew dozens of comments and very extensive, nuanced arguments. Many of the writers identified fractures in the system that are caused by, as Steve Hyde put it, "the essential problem of having a B-to-B business model that has been forced on what is essentially a B-to-C dynamic."
Areas of agreement: The good news is that the medical profession will become even more adept at treating disease using an ever-expanding arsenal of medical devices and by reaping the knowledge gained from stem cell research, many readers said. Another common observation was the need for patients to improve their own health outcomes by losing weight, eating better, and exercising regularly. "Our insatiable appetites and remote controlled luxuries have brought a negative rate of return for our health," wrote Ahmad Faraz Alvi.
Echoing the writings of HBS professor Regina Herzlinger, several commentators advocated that patients agitate for improvements to the system from the ground up, and also assume a bigger role in managing their own health care. "One fact is evident," wrote Susan Willard. "If I don't make the effort in today's system, there is a very high probability that my many doctors and delivery locations will never have the same medical information about me, and the correct data about my illnesses/treatment events."
Areas of disagreement: Our readers contributed a multitiude of proposals on how to fix health care delivery, ranging from a complete rewrite of the medical insurance system (insuring primary care office visits and generic drugs is like buying car insurance to cover the cost of oil changes, Hyde wrote) to development of an government supported electronic health records program that always has the most up-to-date patient data.
Other writers sided with recent work done by HBS professor Michael E. Porter, who suggests profit motivations in the system be realigned. "We have been paying for procedures, visits, and hospital days rather than health and improved health outcomes," offered Mike Leahy. "Suggestion—realign financial incentives so that we pay for prevention, continuity of care, and improved health care outcome"
Finally, readers addressed the question from professor Hamermesh concerning the role of HBS MBAs in creating solutions to health care problems. "MBAs have a role in improving health care delivery through providing governance structure and creating a framework where the interests of various stakeholders (payers, providers, pharma firms and consumers) are aligned," wrote Rebecca Leung. Others noted that MBA-trained managers can help companies speed innovations to market. Several writers noted that Harvard is building an extensive science research institute across the street from HBS, which will surely spur more cross-taining of HBS students to lead science-based businesses. But Tom Dolembo wondered if the case method of teaching is suited for skills needed in such a highly technical, fast moving arena. "The curriculum at HBS sadly lacks the combination of working knowledge, familiarity with basic processes, and does not develop skills at handling massive revolutionary deconstruction," he wrote.
Robert S. Huckman
Richard G. Hamermesh
Professor of Management Practice
Healthcare Initiative Faculty Chair
Professor Richard Hamermesh is chair of the HBS Healthcare Initiative. And, if you like The Conversation, you may also enjoy What Do YOU Think?, an ongoing dialogue between Harvard Business School professor Jim Heskett and the readers of HBS Working Knowledge.