In 2010, governments across the world will redouble their efforts to reform healthcare.
Indeed, in most countries, they have been trying for decades. But a recent economic jolt reminded us just how tenuous our prosperity is and has given us a new sense of urgency.
But will this renewed impetus, perhaps embodied in Obama´s efforts, allow health reform to succeed in Australia, the USA and elsewhere? Will we be able to reduce costs and improve efficiency? What will the future of our health look like?
Perhaps the only things we can be sure of are that: the debate around healthcare will continue to be a confused and conflated one and, that consumers will continue to demand more and look for ways to get what the government or industry cannot provide.
Health is complex. Its stakeholders are numerous. So our government’s recent inaction on its promised health reform should come as no surprise. If this decade’s experiences in the finance sector are any indication, reform may only happen after a major failure.
The time, place and hour are unclear. But it will be a crisis that radically alters our perceptions of how to manage healthcare. This, I believe, is what’s needed.

While the complexity of health and its numerous politically active stakeholders seem to be the greatest barrier to any reform attempts, there is something even more powerful at play; a confirmational bias amongst our leaders that the current health system is more or less okay. Any major change will inevitably affect multiple groups. But health cannot be fixed with the same thinking that created the problem in the first place.
Our way of thinking about health is 19th century. Our health leaders, including many doctors, are incapable of comprehending 21st century changes to our workforce and infrastructure.
What would you think if 100,000 Australian’s were currently confined to their homes because of a car shortage? Perhaps in a socialist 1950’s state, but surely not here! Or what if I told you that all our hotels were at a 95% occupancy rate country wide? It would be time to invest in the hotel business I suppose. But then when you begin planning your new hotel, you find there aren’t enough trained staff to operate the hotel, and no one will pay to train more. This is the reality of our health system and, in other words, a massive market and government failure.
The debate about how to best manage healthcare will continue to rage. You may not believe in the ability of market forces to correct deficiencies in an industry. But the reality is that we have some massive gaps in health provision that governments seem unable to fix. Innovation is required to fill these gaps, as Clayton Christensen so elegantly described in his book The Innovators Prescription.
Who will drive this innovation? Or put another way, who has the most to lose if healthcare does not improve? The consumer.
The greatest driver of change medicine has seen in the last 5 years is not the introduction of new drugs, surgery or management ideas; it is the empowerment of the consumer. Various studies such as the
Pew Internet and American Life Project are tracking this evolution. The majority of patients now visit their doctors armed with some search engine knowledge. Sometimes, the patient has more accurate or up-to-date information about a topic than the doctor.
Only this morning I was with a father whose premature infant underwent surgery three days ago. His knowledge of what signs and symptoms to expect was impressive. Indeed, one of the neonatologists present asked him if he had any medical training.
This consumer revolution is true
‘end-user innovation’ that will break the stagnation which our governments and medical bodies have caused. If we truly want our healthcare system to improve, we should remove the many barriers to consumer choice and engagement in healthcare. To do this, healthcare professionals, particularly doctors, need to better understand how consumers behave in other markets. We must reconsider entirely what an adequate level of care is. We should be prepared to lose the exalted status we have become accustomed to.
In a subsequent post I hope to describe just how this new landscape might look. In the meantime I welcome any thoughts about this rather philosophical piece.
Gabriel James is a medical student and director of health technology startup company PeriAqua. He has a background in biotech research and development, health and youth leadership education, aid projects and pharmaceuticals. His long-term goal is to encourage novel approaches to health care using the latest technology and management concepts. He previously blogged as Future Health Analyst (www.aushealth.wordpress.com).