Health Alert | The Demand-Side Approach to Changing What Doctors Do

November 16, 2009

In many ways health care is like education. In both fields, we find a sea of mediocrity, punctuated by islands of excellence. Further, the islands of excellence appear to be randomly distributed. By and large, they are not correlated with anything. This is not only true in the United States. It is true all over the world.

The two sectors have two additional common features: (1) the individuals who receive the benefits of the services are separate from the entity that pays for them; and (2) we have completely suppressed the marketplace. As a result, there are no financial rewards for institutions to become excellent. In return for expending greater effort to improve performance, they receive the same (or even less) income.

After the publication of A Nation at Risk about a quarter of a century ago, alarmed reformers decided to study the best schools to determine what they do that works and to use various carrots and sticks to try to get all other schools to do the same. This is what I call the "demand-side approach" to education reform. How well has this approach worked? Miserably.

Continue Reading at John Goodman's Health Blog.