I have been in the United States now for almost a decade and have yet to eat at a Cheesecake Factory. I would like to say that the reason for this is that I have high culinary standards (no self respecting foodie would do that, right?) but in fact, it is not. My husband and I once decided to go after a day of shopping at the Prudential Center in Boston but after finding out that the wait was 1-2 hours, we opted for our favorite South End seafood joint instead. But I have always wondered whether the food and the experience really worth the wait?
Not only does Atul Gawande eat there but he somehow manages to turn an ordinary dinner out with his kids into one of the best written pieces I have read recently on what is wrong with the US health care situation (most of my dinners out with the kids these days ends up with someone vomiting or someone crying). His argument is simple, what makes the cheesecake factor so successful – scale, standardization, and a focus on process – can, and should, also be applied to the health care industry. I once attended an interesting talk by Michael Porter (the 5 forces guy) on the health care industry in which he described the health care industry as the worlds’ largest cottage industry – every hospital and every physician practice working independently and on their own.
This description has always stuck with me as it seemed so perfect. But Gawande argues that this does not have to be the case. If we were all more willing to allow the hospitals to operate more like chains we might be able to get better results (i.e. miso crusted tuna) at a lower price (all for under $15, well plus a few extra bucks for the cheesecake, of course).
Perhaps this might be fine for the high income countries, but might this also be applied to health care in low income countries? It seems that there is already at least a few cases out there where this has happened. The Aravind Eye Hospital is perhaps one of the best known chains out there in global health. It has become famous for churning out high quality and low cost eye surgeries across the developing world. There is reasons to believe that these models can work everywhere. McDonalds has more or less shown this to be true, right?
Yet while Gawande makes the connection between the rise of chains in medicine in better care and lower costs, he also makes the important point that the connection between these changes and outcomes still has not been proven.
Yet it seems strange to pin our hopes on chains. We have no guarantee that Big Medicine will serve the social good. Whatever the industry, an increase in size and control creates the conditions for monopoly, which could do the opposite of what we want: suppress innovation and drive up costs over time. In the past, certainly, health-care systems that pursued size and market power were better at raising prices than at lowering them.
Part of the challenge will be reluctance from both providers and of patients to accept such changes (can we start calling health care snobs healties?). Would you want to have your eyes fixed at the Cheesecake Factory? We’ll if the benefits of such improvements are as good as people say, perhaps we might have people lining up for that too.Share on Facebook