One problem with healthcare in the United States is that consumers don’t control their data and the information about them. Even the employers of healthcare consumers, who are paying for the services provided to patients and often responsible for whether patients have healthcare coverage at all, don’t have access to any of the healthcare data of the employees they pay to cover. Healthcare information is protected by providers and guarded by insurers.
A troubling result is that consumers and employers often don’t know much about the quality of care provided at a hospital or from a given provider, and don’t know about the safety record of providers and hospitals. Outcome measures are sometimes protected by law, and are other times hidden behind complex systems that prevent employers and consumers from finding and understanding the information.
Dave Chase compares the problem this creates to airline travel in his book The Opioid Crisis Wake-Up Call, “No corporate travel department would allow an employee to fly on an airline that suppressed its safety records (even if the FAA allowed it). In the same way, it’s unconscionable to blindly send an employee to a hospital with little or no information on its safety record. If the hospital suppresses that information, go elsewhere and tell your employees why.”
There are many ways in which we treat the healthcare system differently than other sectors for no apparent reason. I wrote about the way we don’t consider healthcare broker’s conflicts of interest in the same way we consider financial adviser’s conflicts of interest. In a similar example as above, we heavily scrutinize any spending by employees for lunches or hotel stays on trips, but we don’t apply the same scrutiny to hospital billing. Our failure to consider safety the way we would for employee travel, even though many employers spend more on their employees healthcare than on their travel, is a failure of how we think about the system.
I think that Robin Hanson and Kevin Simler explain a little of why this is in their book The Elephant in the Brain. We don’t know what medical care is effective and we don’t know which systems and providers are safe, but we do know when someone took time off work for care. We can signal our support for that individual with cards, balloons, and messages about how much we value them and hope they recover quickly. Much of our healthcare system and how we treat it is based on signaling. Accessing care shows others that we have resources and powerful allies who care about us. We also use healthcare to signal to others how much we care about them and what a valuable ally we would be to them. The result is costly, in terms of dollars and health and safety problems.
We have to get beyond this signaling mindset and approach to healthcare if we want to rein in prices and have a safe and effective system. If we want our healthcare to be sustainable for the long run, it can’t be built around signaling, but must actually be built around effective solutions. Employers have an important role to play by demanding the information they need to be accountable in providing valuable health benefits to employees. Hospitals, providers, and insurance companies can’t continue to monopolize and hide patient data, preventing employers and patients from making smart and economical healthcare decisions.
Novel Learning 