A provocative commentary (DA Asch et al. NEJM 2019; 380: 1891-3) notes that the current approach to improving health care costs needs to be reconsidered.
“The physician-patient encounter is health care’s choke point.” Instead of pushing for more primary care visits, the authors recommend greater use of automation. Examples in other industries have included:
- TurboTax -helped reduce need for tax preparer’s
- Automated tellers at banks -reduce costs at banks
- Self-checkout at grocery stores -reduce costs at grocery stores
- Websites to directly arrange travel rather than travel agents
Much of medical care can be algorithmic, including hypertension (which affects one-third of U.S. adults), hyperlipidemia, anticoagulation, diabetes, and “might be far more efficiently managed by a bot.”
“An efficient industry wouldn’t lead with primary care, but would reserve it for cases for which lower levels of support haven’t been enough.”
The authors note that efforts to promote this will require removal of state-based regulation. “There is not legitimate interest that benefits from making it hard for a patient in Kansas to get automated care with third-level support from a physician in Ohio.”
My take: The authors are right in their assertion: “Transformative change in any industry requires breakthroughs in productivity.” Some of these changes are likely to be implemented given the cost escalations facing health care.