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When Uber first entered the landscape of livery service, there was significant backlash from the old guard taxicab cartel. Despite efforts to the contrary, Uber has gained a strong foothold in the urban taxi and limousine service industry. Is healthcare also primed for such a drastic Uber-style revolution?
According to a perspective article recently published in the NEJM, authors argue that archaic service established as the norm in the taxi industry was the motivation behind Silicon Valley providing an alternative. However, the degree of regulations in the healthcare industry likely will make such a revolution not feasible in the extreme, in addition to the fact that, while it may be one thing to risk a sub-par cab driver, patients would not necessarily be as cavalier when considering their health.
The authors state that there are peripheral forces in the health industry, that while not creating tidal waves of change, are nipping away at the core of medical service. Despite the existence of monopolies such as in telecom where considerable political power is wielded, the gap between what patients want and what is offered is not a vacuum – “market forces will seek to fill that void” – even if there are political forces opposed to it.
There are several key barriers in the healthcare sector that hinder an outright takeover of traditional healthcare provision which are:
- State-based licensure
- Country-specific board certification
- Educational prerequisites (prolonged training for doctors)
- Health Insurance Portability and Accountability Act (HIPAA)
- Poor interoperability of electronic health records
- Restricted referral networks
There will be innovative answers to scale these barriers that will be driven by competition to gain a market share and flaws that exist in the U.S. healthcare system will be the impetus behind that.
The authors state that providers have three choices:
- Ignore innovators and hope for the best
- Call for increasing regulation to make it harder for innovators to enter the market
- Compete on quality and efficiency
Just as there are consumers who have unmet demands, I feel that medicine, as it is now, is a ticking time bomb. With the degree of physician burn-out, which seems to be getting worse rather than better, and the mounting demands on doctors to provide a course of customer service with a side of healthcare, I feel that whatever revolution does take place, it will not happen unless doctors achieve a greater degree of autonomy instead of being cogs in a wheel, as they have been.
