One problem faced by a society that is always working toward solutions to various problems is that certain solutions, however effective, may go unused because they cannot be commodified.
Consider obesity. True, billions of dollars have been made selling all sorts of diet and exercise and weight-loss products, but perhaps the best solution is the free one: eat a bit less and a bit better and take a good 30-minute walk every day. But it’s hard to make money pushing that idea.
In this interview with The Takeaway, the author and surgeon Atul Gawande offers another compelling example. Gawande’s new book, The Checklist Manifesto (see Levitt’s strong endorsement here) describes his effort to create a checklist for use in surgical settings that could cut down on errors.
The checklist, piloted in eight hospitals around the world, proved to be very successful. It was also essentially free. But, as Gawande explains in the Takeaway interview, widespread adoption has been far slower than he would like. Why?
If a pharmaceutical company came up with a drug or a device that offered the same improved outcomes as the checklist, Gawande notes, that drug or device would be worth billions of dollars, and would be marketed accordingly. The lowly checklist, meanwhile, has no such sponsor and therefore is far slower to spread.
Here’s hoping that the checklist, along with other cheap and simple solutions, can somehow keep worming their way into the marketplace, despite competition from much better-promoted (and often inferior) ideas.
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Re: “if it’s free, then no one stands to make money off it. This disincentivises a large number of people … ”
Thus, churches should not exist – or, if they do, they should not be popular. Certainly, you shouldn’t find them in every town in America.
That a good solution is free will keep *some* corporations from working for it; however, the economy is not only healthcare; there are corporations on the other side of the equation (see the Leapfrog Group for an example). There are, in fact, ways to promote this kind of solution; they’re just not always used.
Sidenote: one way to promote this kind of innovation is through regulatory methods (that’s often the way to equally apply a cost-inducing requirement across an industry).
I think with things like this, you need to first focus on the upcoming generation. It is a lot easier to sell this idea to medschools, the incentive is for their doctors to be the most efficient, best doctors they can be. While there will certainly be some institutional inertia there as well, getting the checklist idea embeded into medical training itself is the best way to have doctors stick with it long term.
The overpopulation problem could be solved by the widescale promotion of self-help books and special procedures and study guides for getting pregnant and having babies.
It will just be too much trouble.
I’m pleased to inform you that the surgical checklist is compulsory in every hospital in France since january the first.
the use of this list is supposed to halve post surgery problems.
You bring up a great point: a lot of things with huge net benefits are hard to make money off of.
But hard doesn’t mean impossible, and I can see a lot of room for growth in the “walk 30 minutes and eat less” market, especially if the whole thing was mixed with a good dose of social networking.
If someone could come up with a way to put the individual in touch with the group easily and cheaply, there’s a goldmine there.
Because errors cause death, and no one in the medical industry is paid to keep us alive and healthy. They’re just paid to do stuff, or to pay providers when we get sick.
In an industry like retail, this would be called “supply chain re-engineering” or “logistics”, and you could make buckets as a consultant.
The idea to “eat a bit less and a bit better and take a good 30-minute walk every day” is obviously free. However, actually eating less and walking 30 minutes every day is not free. There are real costs for food and opportunity costs for walking 30 minutes.
The same is true of a checklist. The idea and draft of the checklist may be free, but using it has some opportunity cost. It appears the studies show that the opportunity costs are well worth it in terms of improved patient outcomes, but that doesn’t mean that there is no upfront cost to using the checklist.
Well, this is part of the big argument for substantial government involvement in health care because it is subject to so much market failure. If the hospital were a corporate factory, the VP of Ops would have an incentive to save costs and improve quality so she’d love a solution that were free.