am 4. April 2011
Even though the book is mainly analyzing the US situation its findings are of relevance for all efforts to make health care systems more efficient. The authors point out the major shortcomings of the present zero-sum competition system that is mainly shifting costs among the various participants but has resulted in inefficiency and substandard quality. They show that the remedy to zero sum competition should not be a single-payer system as advocated in some European countries as health care delivery is simply too complex, too individualized, and too innovative to be manageable by top-down micromanagement of some central agency. The authors make a convincing pitch for replacing cost based by value based competition related to the full cycle of care of specific medical conditions. As in any other part of the economy such a switch would result in higher quality at in many cases lower costs due to more accurate diagnoses, less invasive treatments, faster recoveries, and fewer complications and errors. To make value based competition effective information on results (medical outcome and cost over full care cycle) has to become widely available and patients, referring physicians, and health plans have to be allowed to choose health care providers based on their results in treating a specific medical condition wherever they are located. This will shift demand from low to high quality providers and improve overall patient value. Establishing competition on the level where it really matters, treatment of specific medical conditions, will also allow for more innovation as providers will be incentivized to improve quality of care. Any centralized system will on the other side increase bureaucracy and end up in micromanagement of care delivery.