Mind the Gap in Healthcare

By: Laura Mortimer What is good healthcare? Is patient-centeredness possible?

Despite working in the same healthcare “system,” leaders in business, medicine, and public policy often answer these questions differently.

 I spent Saturday at a healthcare conference titled “The Evolving Healthcare Landscape: Mind the Gap Between the Patient and the Healthcare System” at the Fuqua School of Business. The conference was excellent, though I’m still a little unclear on what it means to “mind the gap.”

A more progressive approach might have been to fill the gap, or at least explore it further and understand it better. Why are patients disconnected from the system in so many ways? Why is this chasm dangerous? What does it cost us?

Also, why did the conference organizers not make more British puns about the London tube?! Lost opportunity.

A good starting point for answering these questions would be to examine various perspectives of major players in the U.S. healthcare system – leaders in medicine, business, and public policy. Success from a physician’s perspective may look very different than success from a pharmaceutical executive’s perspective, and so on.

Not to mention the patient’s perspective, which remained noticeably absent from much of Saturday’s conference.

That may have happened because patients are not the power players in our healthcare system. Patients stand at the receiving end of long chains of negotiations, market forces, and scientific developments. Consequently, the popular move toward a more “patient-centered” system is much easier said than done.

The conference’s keynote speaker from GlaxoSmithKline – the world’s fourth largest pharmaceutical company – discussed his company’s efforts to bring its customers’ voices into the research and development process for drugs. However, GlaxoSmithKline’s customers are large hospital systems, not patients.

The keynote speaker talked about the need for greater patient adherence to medications. I couldn’t help but wonder, has this man ever considered that some patients may not adhere to their meds because they can’t afford regular refills? Or because what he assumes is a simple trip to the pharmacy requires two buses and a babysitter? Or any of the other circumstances that a truly patient-centered system would consider?

The gap between patients and system is large. And, despite all the rhetoric, it doesn’t seem to be getting any smaller. Who will change this? Who has incentives and power to change it?

Publicly traded companies like Glaxo must honor their fiduciary responsibility to their shareholders, so their greatest incentive is to maximize profit. Physicians are responsible to the oath they take to do no harm and provide the best possible care for every individual. And policymakers are responsible for the whole – for maintaining civic environments that are ripe for both businesses and individuals to flourish. Again, easier said than done, especially when goals within the healthcare system often conflict.

Public policy may be the best tool we have to promote societal health and make “the gap” less costly. Policy can help align the goals of different players in the healthcare system and give patients more agency. The Affordable Care Act moves us forward a few steps, but we still have a long way to go before honestly saying that our system provides good, patient-centered care for every American.

Priceless? Really?

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