Market-Driven Healthcare: Who Wins, Who Loses in the Transformation of America's Largest Service Industry

Rating:
Summary: Excellent and unique application of the "Focussed Factory"
Review: Any health care analysis is going to be wide ranging and possibly a little rambling. This book is no exception.

Regina's book makes a good case for individual responsibility for health care purchases, though that may be a difficult and extended transformation.

A more important point for me was applying the "Focussed Factory" concept to health care delivery. This is such an ideal approach for chronic disease management or popular surgical procedures. Regina sites statistics and actual patient outcomes to effectively make her argument.

The "Focussed Factory" is something we can implement right now. That may be the core value of this book.

Rating:
Summary: Brilliant
Review: Finally, someone has produced a well-researched and articulate portrait of the largest, and most flawed, industry in America. Herzlinger emphatically proves that the plague in American health care is simple: consumers have been robbed of the power to control the market; a conclusion that has been dictated by common sense since Adam Smith's Wealth of Nations but which has not been delivered in one concise package until now. "Policy Wonks" and Bean Counters beware: Herzlinger proves that a free and open consumer-oriented market, and not volumes of stipulations and regulations, will propel the helath care industry to the apex of efficiency

Rating:
Summary: There is no "market" in American medical care, period.
Review: Market forces cannot solve the medical crisis. No market exists. Knowledge of what is sold is inequivalent: if patients knew the difference between colonoscopy and colposcopy, they would not know the fair market value of either procedure. Unlike buying a car, where the dealer knows you can walk off, patients cannot negotiate, and can't determine the quantity of medical services needed. Eyeglasses constitute a misleading example. Physicians are the principal drivers of all expenditure on medical care. Without a medical license, nothing can be ordered or prescribed. This fact must be faced squarely: the supplier of services regulates the level of demand for medical services. Annual outlays have now reached $1.6 trillion with no end in sight to the physician-driven escalation in expenditures. This is not COST inflation, but relentless EXPENDITURE INCREASE driven chiefly by an oversupply of medical doctors. If this system is ever to be fixed, these stubborn realities must be faced. This author evidently has no clue that there is not a "market" operating in the world of medical care delivery, thus her analysis is unhelpful.

Rating:
Summary: So she's no Tolstoy, but the ideas are great.
Review: No one will accuse Ms. Herzlinger of being a great writer, but her conversational style is easy to read and she does have some good ideas for how the healthcare industry should be. Ideas that still haven't been implemented even now, 8 years after it was written. She does make a fairly convincing argument for how focused factories could reduce costs. In addition, suggestions that everybody should have health insurance, that healthcare providers should not be insulated from market forces, that consumers are the ones with the real power to stop the soaring healthcare costs, and that they'll only curtail spending when given incentive to do so are good points that can't be made often enough. Points that seem even more relevant today given the continued increase in healthcare costs, the inability of the HMO system to manage them, and the spiraling problem the growing uninsured population is creating (the more uninsured people there are, the more insurance costs, which increases the number of uninsured, etc.). She has good ideas, I think it's time people listened. It's of vital importance that the healthcare system incorporate what's great about America, what has made America a leader in every other industry: innovation and sensibly regulated free markets. Ms. Herzlinger gives us a good way to get it done.

I also have to ask if some of the other reviewers actually read the book. The author gives a pretty good analysis of how focused factories would reduce costs, using that 20% of the people produce 80% of the costs as a cornerstone of her argument. Also, she cites physicians' inability to deal with market forces as a cause of the problem and gives suggestions for how to deal with it.

Rating:
Summary: Excellent and unique application of the "Focussed Factory"
Review: Professor Herzlinger offers a fatally flawed vision of health reform, based on a persuasive premise: the absence of focused factories in the US health care system needlessly diminishes the quality of care and increases its cost. She thus concludes that not only is withholding focused factories uneconomical but also unethical.

Agianst this, she seems to be unaware of the ethical conflicts of interests created in the system she envisions, which led Dr Linda Peeno, working as an HMO executive to conclude that she felt part of some psychology experiment whose design was to see how quickly those of us in the health profession abandoned our humanity.

The lessons for the health profession and the risks posed by focused factories are clear: given our endangered integrity, we have an ethical obligation to end the strained silence while our professional integrity is rationed away. A Jerome Kassirer noted, to capitulate to an ethic of the group, I would add like a focused factory manager, rather than the individual patient, allowing market forces to distort our ethical standards will inevitably lead to the suffering of our patients and our profession. Ultimately if we adopt Herzlinger's vision for health reform, we risk becoming the economic agents of focused factories.

George Halasz Australia

Rating:
Summary: Fatally flawed vision of focused health factories
Review: Professor Herzlinger offers a fatally flawed vision of health reform, based on a persuasive premise: the absence of focused factories in the US health care system needlessly diminishes the quality of care and increases its cost. She thus concludes that not only is withholding focused factories uneconomical but also unethical.

Agianst this, she seems to be unaware of the ethical conflicts of interests created in the system she envisions, which led Dr Linda Peeno, working as an HMO executive to conclude that she felt part of some psychology experiment whose design was to see how quickly those of us in the health profession abandoned our humanity.

The lessons for the health profession and the risks posed by focused factories are clear: given our endangered integrity, we have an ethical obligation to end the strained silence while our professional integrity is rationed away. A Jerome Kassirer noted, to capitulate to an ethic of the group, I would add like a focused factory manager, rather than the individual patient, allowing market forces to distort our ethical standards will inevitably lead to the suffering of our patients and our profession. Ultimately if we adopt Herzlinger's vision for health reform, we risk becoming the economic agents of focused factories.

George Halasz Australia

Rating:
Summary: Old wine in new bottles
Review: Regina Herzlinger's "focused factories" of tomorrow are the "centers of excellence" of the 1980s. Both concepts are fine for metropolitan areas but ignore several important facts: 1. 80% of health care resources are consumed by 20% of the population, the elderly and very young; 2. There are about millions of people who neither live in areas large enough to support such "factories" and lack the financial means to travel to them. 3. Consumers are concerned largely with price and convenience, and secondarily with outcome. They have no basis by which to compare technologies (such as mammogram machines, as she suggests). 4. Patients aren't paying the bills. Consumerism isn't a panacea. Patients have no idea what health care truly costs, equating cost with price. Physicians haven't been much help either, since they lack sound business sense and have been shielded from market sources for decades. The "solutions" at the end of the book appear to have been pasted together to meet a deadline instead of being carefully constructed with adequate supporting arguments. It is reminiscent of the cartoon of two scientists next to a blackboard covered with equations, one of which is "and then a miracle occurs." Finally, Herzlinger made the same mistake as Hillary Clinton. Physicians are not about to accept changes in their system made without their input. Ultimately, they still deliver the product and, unless one can figure out how to construct a health care system sans physicians, one must include them in any talk of reform. David A. Rivera, MD [e-mail]

Rating:
Summary: Old wine in new bottles
Review: Regina Herzlinger's "focused factories" of tomorrow are the "centers of excellence" of the 1980s. Both concepts are fine for metropolitan areas but ignore several important facts: 1. 80% of health care resources are consumed by 20% of the population, the elderly and very young; 2. There are about millions of people who neither live in areas large enough to support such "factories" and lack the financial means to travel to them. 3. Consumers are concerned largely with price and convenience, and secondarily with outcome. They have no basis by which to compare technologies (such as mammogram machines, as she suggests). 4. Patients aren't paying the bills. Consumerism isn't a panacea. Patients have no idea what health care truly costs, equating cost with price. Physicians haven't been much help either, since they lack sound business sense and have been shielded from market sources for decades. The "solutions" at the end of the book appear to have been pasted together to meet a deadline instead of being carefully constructed with adequate supporting arguments. It is reminiscent of the cartoon of two scientists next to a blackboard covered with equations, one of which is "and then a miracle occurs." Finally, Herzlinger made the same mistake as Hillary Clinton. Physicians are not about to accept changes in their system made without their input. Ultimately, they still deliver the product and, unless one can figure out how to construct a health care system sans physicians, one must include them in any talk of reform. David A. Rivera, MD [e-mail]

Rating:
Summary: Admirable goals,solutions ignore some regulatory constraints
Review: The author accurately identifies a subpopulation of patients who are middle class,time constrained, and annoyed with the difficulty of obtaining quick evaluation and therapy for a variety of health problems of varying complexity. After examining a number of systems for health care delivery, she gives the nod to highly specialized and focused units such as the Shouldice Clinic for hernia surgery in Canada. There are several problems with the soultions she proposes: 1) Goverment regulatory agencies and third party payers currently refuse to pay multiple consultants for seeing a patient on the same day. 2)Patients with complex multisystem problems may be ill served in such a focused system- eg. the patient who has congestive heart failure and a hernia. 3)There would monumental problems with education of medical students and residents in such a system. While this is a secondary consideration in a market driven system in which there is a physician surplus, if we fail to adequately educate physicians for future generations the law of supply and demand will ultimately come back to haunt us.

Rating:
Summary: Where was the editor?
Review: There's a good idea or two in here. You won't have any problem at all finding out which one - there are only two in the book. These are: 1. Health care will become more of a consumerist industry 2. Focused factories are excellent vehicles for delivering care These are pretty damn sensible ideas. Policy wonks, though, already know this. And others, frankly, should not read this book, since it is (somewhat) careless in its factual delineation of how the HC market operates. If you can, track down some of RH's shorter papers. They're pretty durn good.