A Place for Smallness in Health Care


Small Is Beautiful: Economics As If People Matter

Ernest Friedrich Schumacher (1911-1977), Title of His Book (1973)

In most last blog, “Bigness Begets Bigness in Health Care”, I wrote how health care businesses are caught in the grips of massive consolidation, triggered by the rise of big government.

In this post, I wish to stress small can be beautiful too. Smallness in health care is occurring simultaneousily with Bigness in health care.

It is useful to compare things great and small. Each has its virtues. In his 2015 book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, Robert Wachter, MD, described this binary problem well, “Medicine is at once an enormous business and an exquisitely human endeavor.”

A human endeavor health care is indeed. Health care is about our health, from birth to death. It’s about sickness and wellness. It’s about patients-doctor interaction. It's about economics - spending your money and other people’s money. It’s about fairness and waste, and the blend of the two when spending other people’s money in government health programs. With centralized care, more people are covered but anything goes, and humanity get lost in the regulatory blizzard. It’s about the need for more efficiency, which Big Business and Big Government, never seem to deliver.

But in the end, it’s also about privacy, confidentially, and hand holding. People are seeking kindness, listening skills, and bedside manners among physicians. And in these realms, smallness not bigness matters.

Physicians are beginning to buck the trend towards bigness by retreating into something called direct primary care, or its off-shoot concierge medicine.
By doing so, they are trying to preserve their autonomy and patient and doctor relationships.

Physicians are paring down, the number of patients they see each year, from 2000 to 3000 or more to 500 to 1000, in order to cut through the bureaucracies and regulations that have engulfed medicine and to what they are trained to do, engage with patients.

Physicians are cutting their practice overheads and costs to patients by not accepting patients covered by third parties, by not being slaves to time consumed by data and coding entry and documentation for insurers and government.

They are delivering bundled prices for a variety of services in their offices, including routine tests and minor surgical procedures.

They are telling patients precisely what to expect for their money by posting prices in advance in their offices and on the web.

They are offering same day scheduling.

They are giving out their cell phone numbers. and they are answering patient emails.

They are spending more time with patients, addressing their concerns, listening carefully to their complaints, explaining what it takes to stay healthy, and unraveling the intricacies of treatment and payment and government policies.

They are being more personal, for medicine is a very personal business.

Health care is a big business, but it’s a small business too