It is interesting that the best health care investment returns come from protocol-driven models. Those models say that under a given set of circumstances, you are expected to do certain things. Such models exist already in law enforcement, public education and air traffic control, to name just three examples. There is a standard, presumptively correct way to handle a situation; with the right reserved for the individual police officer, teacher or pilot to make reasoned adjustments from the norm as they believe circumstances require.

            Health care in the United States, for the most part, is not a protocol-driven industry. There are many reasons, the most important of which are the profit motive of device manufacturers, hospitals, the pharmaceutical industry, insurers and professional groups; and the problem of non-standardized care.

            An operations analysis of thousands of individual medical decisions; looking at the differences in treatment for major health problems – and the results in each individual case — will spray points on a graph. The graph might, as an example, show the longevity of people with a particular form of cancer, depending on whether they selected surgery, chemo, radiation, or no treatment.  Analysis of the distribution of data points can show hospitals or insurers how to make policy adjustments to generate more positive outcomes.

             This result-oriented procedure makes more sense to me than the current fee-for-service double-incentive situation in which we motivate doctors to order unnecessary tests – placing more money in their pockets and reducing their risk of malpractice for having missed something. Revising protocols based upon outcomes of large numbers of similar cases would be so much better than allowing health insurers to raise the price of coverage out of reach of someone with a pre-existing condition; or terminate the coverage of someone who developed a serious illness.

            Here is a chart of the difference between health care driven by results (on the left); and driven by profits (on the right).

Systems analysis (consisting of pattern matching and rate estimation) yields a protocol. The protocol is like the flight path a pilot is expected to follow unless, for example, they encounter turbulence and seek modification.

Medical decisions are non-standardized (more random). Each doctor recommends medication and treatment based upon his or her personal experience and knowledge base. Studies show that experience is often distorted by facts that are more recent or more memorable.




Based upon personal observation


            The column on the right is more representative of the current health care delivery system in the United States. To save money and improve the health of Americans at the same time, our model should be more like the column on the left.