Healthcare
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Healthcare
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Re: Healthcare
#2Education and health care are both dominated by government as the single largest player in the marketplace. The U.S. government actively sets the number of doctors, the types of procedures that can be covered by insurance, and dominates market spending through its Medicare, Medicaid, and VA programs. And if you aren't on a government program, the tax code forces you into a employer-provided insurance ghetto.
Healthcare innovation will remain low, and costs will continue to grow at double digits, until America passes real healthcare reform. Allow insurance competition across state lines, give private individuals the same tax treatment as employers when buying healthcare, and allow individuals to form groups to purchase health care (e.g. alumni groups, church groups, etc). Those three steps would go a long way to opening up the industry to the web and to innovative, competitive forces.
Re: Healthcare
#3The problem with venturing into healthcare is dealing with highly regulated industry and wrong incentives for most of the players.
"Large networks of engaged users" do exist, but the ones who control real money (doctors, hospitals, insurers and pharmas / device makers) are highly suspicious of outsiders. Every one of them has the incentive to not share their data with the competition, even though they will all publicly pay lip service to doing this in the name of "improving patient care".
If you look at patients / consumers, you can roughly divide them into the healthy and the sick. The healthy ones generally speaking do not want to invest time and effort into their health, unless it overlaps with lifestyle / food / entertainment - well covered by ventures we do not normally put into "healthcare" category. If you look at the sick ones, they tend to skew to the older demographic with lower online literacy. Even when you pick out the ones active online who care enough about their conditions what you get at best is small niche communities like PatientsLikeMe.com that are at best able to function as support networks and clinical trial recruiting sites.
Did I forget to mention that pharmas and device makers are mortally scared of participating in social media because of FDA? They are in business where even acknowledging any adverse event could make them liable for billions. This is a great example of why for most of the healthcare industry social media is all downside and very little upside.
Re: Healthcare
#4Education and health care are both dominated by government as the single largest player in the marketplace. The U.S. government actively sets the number of doctors, the types of procedures that can be covered by insurance, and dominates market spending through its Medicare, Medicaid, and VA programs. And if you aren't on a government program, the tax code forces you into a employer-provided insurance ghetto. Healthca…
I don't think more small risk pools are a good solution, due to adverse selection. The very sick or old often need more treatment than they can possibly afford (because what we develop isn't limited to the value of the typical patient's labor, which is a good thing!) so our choices are to let them die through triage, or to subsidize their treatment by preventing the well and young from gravitating into cheaper risk pools which find ways to exclude the sick or old. Tax-funded Medicare and Medicaid are effectively additional risk pools you're paying for even when they aren't covering you, and yet they aren't really acting as insurers of last resort (except for certain people who meet the criteria).
Re: Healthcare
#5I have worked on healthcare software for the last decade. Healthcare technology is really not something that one can understand from the outside. It is also not an area where web startup knowledge is as applicable (eventual consistency is entirely unacceptable, any caching of data must be very precise to avoid showing stale data to users and is generally not done, all sales to hospitals and most physician groups are "enterprise" sales). There are many different standards for data transmission, but none of them are required and most people see them as more of a recommendation. Non-technical people are put in charge of technical projects.
That being said, it is not a technologically challenging industry at the moment. Most of the work that is being done is just automating existing paper-based systems. The regulations that everyone worries about are really not very onerous. Complying with HIPAA is mostly common sense and the FDA does not yet regulate most information systems unless they control medical devices or provide specific types of alerting (vendors are preparing for the day when they do).
Two of the biggest challenges that I see are the caliber of the technologists in the industry and the absolutely disgusting new interoperability standards that are being developed by people with questionable technical skills.
The company to watch at this point is Epic (I do not work for Epic). They are really crushing a lot of other companies and they are somewhat progressive.
If people are interested in some of the technology that is being used in the industry outside of the standard .Net and Java stuff take a look at InterSystems. They even have all of their product documentation online, which is a bit of a rarity for enterprise vendors.
Re: Healthcare
#6Education and health care are both dominated by government as the single largest player in the marketplace. The U.S. government actively sets the number of doctors, the types of procedures that can be covered by insurance, and dominates market spending through its Medicare, Medicaid, and VA programs. And if you aren't on a government program, the tax code forces you into a employer-provided insurance ghetto. Healthca…
or, those individuals could form an even larger group to ensure equal coverage for all people. could call it a state or a country or civilization.
the government is people.
Re: Healthcare
#7Education and health care are both dominated by government as the single largest player in the marketplace. The U.S. government actively sets the number of doctors, the types of procedures that can be covered by insurance, and dominates market spending through its Medicare, Medicaid, and VA programs. And if you aren't on a government program, the tax code forces you into a employer-provided insurance ghetto. Healthca…
Fortunately for students education had fewer licensing requirements than healthcare. This allowed for the home school loophole, and for a network of alternative education providers to slowly grow and flourish outside of government control. Healthcare faces much stricter regulations as to who can provide care and how they administer it, so I expect much less change and improvement.
Re: Healthcare
#8Education and health care are both dominated by government as the single largest player in the marketplace. The U.S. government actively sets the number of doctors, the types of procedures that can be covered by insurance, and dominates market spending through its Medicare, Medicaid, and VA programs. And if you aren't on a government program, the tax code forces you into a employer-provided insurance ghetto. Healthca…
First, most Americans fall outside Medicare, Medicaid and the VA programs. The government currently does not regulate individual/employer coverage. I would not characterize the entire private insurance industry as an "employer-provided insurance ghetto" - what does that even mean?
The whole second paragraph makes it clear that you don't understand the complexities of the Healthcare industry. You provide very broad brush statements like "allow insurance competition across state lines", the complexities of that single issue alone are staggering. Are you aware that the strength of most in-state insurance carriers is their in-state network. An insurance company IS it's network. In addition each individual state has a Department of Insurance which also regulates all carriers in that state. DOI rules and regulations vary from state to state. Expanding your coverage to another state is a very complex undertaking.
Also, Individual groups do have the ability to purchase healthcare - see many professional organizations(AIGA, etc) as working examples of this today.
In either case, making those changes won't just magically open the industry to "the web and to innovative, competitive forces". There are already competitive forces at play. Any new player attempting to join the fray faces an uphill battle just in the regulatory aspects of the business alone.
What do the advantages of the web and new technologies bring to insurance? How do these changes the provider networks which are the backbone of major insurance coverage today? These are the types of questions which need to be posed, and the people in the best position to answer these questions and change the game are insurers themselves. There are many smart and talented people working in insurance. The recent proposed Healthcare changes have helped to begin the process of moving forward and thinking differently, but with an industry like this it will take time.
It is happening, insurance providers are looking at new technologies and ways to provide the coverage that people expect, for lower costs, in new and different ways.
Re: Healthcare
#9Education and health care are both dominated by government as the single largest player in the marketplace. The U.S. government actively sets the number of doctors, the types of procedures that can be covered by insurance, and dominates market spending through its Medicare, Medicaid, and VA programs. And if you aren't on a government program, the tax code forces you into a employer-provided insurance ghetto. Healthca…
First, most Americans fall outside Medicare, Medicaid and the VA programs. The government currently does not regulate individual/employer coverage. I would not characterize the entire private insurance industry as an "employer-provided insurance ghetto" - what does that even mean? The whole second paragraph makes it clear that you don't understand the complexities of the Healthcare industry. You provide very broad br…
>"The government currently does not regulate individual/employer coverage."
Are you sure about that? Last I checked, the feds mandate an immense number of details about how private insurance is provided, and that is only growing with the new health care law.
>"I would not characterize the entire private insurance industry as an "employer-provided insurance ghetto" - what does that even mean?"
1 of every 2 dollars spent in health care in the US is spent by the government. These three programs are clearly the 800 pound gorillas in the room. Medicare's price controls directly drive shortages and oversupply, and its billing practices set the standard for the rest of the industry.
Re: Healthcare
#10Education and health care are both dominated by government as the single largest player in the marketplace. The U.S. government actively sets the number of doctors, the types of procedures that can be covered by insurance, and dominates market spending through its Medicare, Medicaid, and VA programs. And if you aren't on a government program, the tax code forces you into a employer-provided insurance ghetto. Healthca…
clayton christensen advises that the solution to healthcare is personalized medicine, technologies like portable diabetes monitors. Imagine if you needed surgery, a robot comes to your house and performs it, much cheaper than doctors and hospitals. such system are currently being developed with military funding - battlefield telerobotic surgery