How Can Healthcare Be So Good and So Bad?

Over the last few days, I’ve got to experience both the good and the bad of the healthcare system in the US. You see, my daughter was a bit over-adventurous with her parkour in the playground and broke her ankle trying to leap from a ladder to a set of monkey bars.

(Not really my daughter’s foot, and not really a broken ankle)

So, the bad first. It is a nightmare to get approval for specialists. You need to get referrals, authorizations, check with insurance, and schedule appointments right away to make sure you don’t lose a time slot, and then cancel and shift them around once the paperwork is in order. There’s an amazing amount of waste for all parties involved. Long explanations, multiple calls, research, and so on. Fortunately for me, it was my wife who did all that legwork. She, of course, did not feel as fortunate.

It all comes down to a supplier network that is competing with each other. The insurance company doesn’t want to pay for a specialist. Primary care doctors don’t want to increase their potential liability by not taking every precaution they can think of. And we, as the patient/consumer, want to get the care we think we’ve paid for in our premiums each month.

Now, in most business relationships, there is some competition. Suppliers and manufacturers both want to get the biggest slice of the profit pie, but the end goal is the same. Every supplier up and down the value stream agrees that the customer buying more is better than the customer buying less.

Not so in health care. When a patient walks in the door of a doctor’s office for anything but preventative medicine, the physician wins, but the insurance company loses. Hard to picture a supply chain that is more adversarial.

Now, on to the good. My daughter’s boot is a marvel. She’s going to have it on for 4-6 weeks, and yet the materials aren’t bothering her despite wearing it 24-7. It adjust with straps and Velcro, but then has a pump that applies the final even bit of pressure. Someone put their ingenuity to use to come up with that contraption. Plus her crutches are lightweight, sturdy, and feature quick adjustment points. The switch from wing nuts and wood on older crutches to these push button quick releases is straight out of the SMED 101 manual.

So, back to the bad. I’m curious if anyone can think of another type of transaction where a consumer pays two competing entities to battle it out about how to provide a service. The closest other example I can think of is when hardware and software techs blame each other, but during the initial purchase, both companies would have won. So are there any other win-lose situations at the moment of purchase for a consumer?

Note: The foot xray is courtesy of  user “JoJo”  on Wikimedia Commons.