Good Healthcare is the Cheapest Healthcare (Financiële Dagblad 12-16-2005)

Management guru Michael Porter warns the Dutch Healthcare sector: “Do not make the same mistakes as we did.”

By Eric Bassant

LEIDEN- Prof Michael E. Porter of the Harvard Business School gave his view on the modernisation of the Dutch Healthcare system on Thursday.

At the invitation of the Ministry of Health, Welfare and Sport (VWS) he gave a lecture by means of an online video connection from Cambridge, MA to the participants of a conference on the changes in Healthcare. Porter has been a leading researcher on market principles for a number of years. In the early nineties he established his name with a study on the competitive advantages of nations.

He passionately applauded the principles behind the new Dutch Healthcare insurance, which will be implemented on January 1^st.”The basic direction is a good one, but you are not there yet”, said Porter.

He thinks it’s a good thing that there will be a single, uniform standard healthcare package for everybody in the Netherlands. Secondly, it’s good that there will be more competition. But be careful, warns Porter. Do not only pay attention to the costs of healthcare. In time that will only increase expenditures.

“Insurers in the United States have focused too much on the costs and not on the quality of care for the patient. In the beginning that lowered the healthcare expenditures, but the costs only increased afterwards. The paradox here is that the more the costs of care are lowered, the more the eventual costs of care will rise”, said Porter.

Competition based purely on price is doomed to explode according to Porter. “In the United States there are 139 centres where hart transplantations are performed. That’s too much. It’s expensive and not good for the quality.”

A patient that stays healthy in an early stage because he was helped quickly and adequately is still the cheapest solution. “You must go in the direction of competition on medical results”, advised the professor. That’s why it’s necessary for the medical profession to organise itself around diseases.

Integrated teams should arise to tackle diabetes or asthma and the results of these teams should be published.

The Harvard professor thinks that specialists in the USA and in the Netherlands are working too fragmented and that they all intervene in their own way. “It evolved that way over time, but it’s desperately old fashioned. A patient wants someone who knows the whole process”, says Porter.

According to him cooperation between professionals leads to better care, less mistakes and quicker diagnoses.

Information about delivered quality is essential. Patients must know which doctors are good. Presently they go to the doctor around the corner because they think all doctors are equally good. The insurers should communicate more about this subject too, in order to make sure people know that the price level of a premium is not the only thing they should pay attention to. “In the United States insurers have become the opponents of the doctors. That has lead to higher costs”, said Porter.

At the end of the lecture the Minister of Health Hans Hoogervorst asked how to cope with the term ‘quality’. “In what way should the insurers deal with that?”

Porter refers to Singapore and Sweden, where result measuring is more widely spread. In the USA databases exist which contain the results of for instance transplantations. “It’s a matter of will. There’s a lot of resistance among doctors because they are afraid they aren’t treated fairly”, said the professor.

Hoogervorst promises Porter that the Dutch Healthcare sector aspires to achieve a higher end-term-grade. The professor finally, takes the opportunity to promote his latest book, which will be available shortly.