Late last week, I posted an analysis of the potential and pitfalls of the current Health 2.0 movement. It was developed in response to a public argument currently taking place between Dmitriy Kruglyak and Matthew Holt about whether Health 2.0 is supported by the fundamentals. In my post, I outlined a framework I believe will be useful for those attempting to determine whether Health 2.0 companies will be successful in the long term.
I was honored to see that other observers took a hard look at my analysis and provided their own perspective on the issues I raised. Most significantly, Vijay Goel, MD “classifies the [market] opportunities differently” than I do, expanding on my focus on consumer/provider decisions, information flow, finance and therapeutic advances. Goel also disagrees a bit with my take that Health 2.0 companies will have to prove their mettle to existing health industry players. Instead, he suggests that we need to focus more on the impact consumers are having on the fundamentals of the health system and build new metrics to evaluate whether businesses are harnessing consumer energy appropriately.
Goel wasn’t the only observer to suggest that I have not focused enough attention on the impact of the Internet and technology empowered consumer on the health system. Janet Johnson left a comment on this blog noting that industry players need to understand the role consumers are playing, especially in the area of health content creation and exchange.
I have often talked about the impact of consumers on the evolving health system on this blog and elsewhere. Indeed consumers (defined as medical professionals, patients, caregivers and others) have a central role to play in the Health 2.0 movement. However, I am also careful not to overestimate their impact. There are some areas where Internet-empowered consumers are going to be central and other areas where they will play a strong (or weak) secondary role.
Overall, I think that observers of the Health 2.0 movement tend to ascribe a little
too much power to consumers. Realists will understand first of all that the U.S. health system is not a free market and providers, patients and others have imperfect information. This (and other factors) limits their influence on the system’s fundamental drivers. However, there are some areas where they are having an impact. Specifically: -Consumers Are Central To Medical Decision Making: Time and time again, we have seen consumers influence decisions about which medicines and therapies should be provided to patients. For example, today, Ed Silverman of Pharmalot reported that the FDA has decided to conduct a clinical trial to determine if the generic version of the antidepressant Wellbutrin is truly safe and effective. The FDA was prompted to take this action after reviewing hundreds of postings on the Website the People’s Pharmacy indicating that the generic caused significant side effects.
-Consumers Play A Central Role In Information Sharing: We have seen numerous studies and other evidence that consumers are seeking and (to a lesser extent) creating health information online.
-Consumers Are Secondary To Medical Technology Development: Consumers can certainly have valuable input into the development of medical technology (i.e., the feature set, directions for research), but at the end of the day much of the critical activity is going to be driven by manufacturers and other players.
-Consumers Play A Secondary Role In Medical Financing: Consumers play a very small role when it comes to medical financing. While consumers can help reduce some administrative expenses and the demand for medical services (witness the news reports on how consumers are forgoing care because of cost), we must remember that:
**20% of people with chronic conditions account for 80% of healthcare costs (see this enlightening post from e-patients.net for more).
**Consumers have little impact on health cost inflation, pricing power is firmly with insurance companies, government and providers.
**The healthy affluent will always be in the best position to actively understand and manage health costs. If you look at the closely at the studies (from both sides of the debate) on Health Savings Accounts, you’ll note that the affluent and healthiest are much more likely to have a HSA and be willing to use it for preventive and routine care.
Overall, I think a realistic assessment of the role Internet-empowered consumers play in the health system will help observers and companies understand where the opportunities truly lie. Consumers are very important, but there are some areas where they play less of a role.
"Overall, I think a realistic assessment of the role Internet-empowered consumers play in the health system will help observers and companies understand where the opportunities truly lie. Consumers are very important, but there are some areas where they play less of a role."
...Once again, I appreciate your perspective. I've been in technology for too long, I suppose, at more than 25 years. I see the advent of social media (content creation) and Wikipedia and other resource sites as driving manufacturers to deal with consumers (especially technically-savvy, Internet-empowered consumers) in new ways, and therefore being influenced themselves in new ways.
What I'm beginning to realize is that the thinking process in healthcare and pharma and other suppliers in the industry is more measured. Likely due to regulatory and economic pressures. I shall endeavor to be patient, until I am a patient myself.
And as a Baby Boomer, that's coming too soon for me!
Posted by: Janet Johnson | September 23, 2008 5:25 PM | Permalink to Comment
Consumers are central to medical decision-making - but this can be a destructive force. Winning popularity votes is how 'treatment' like homeopathy gains credence even within respected university programmes!
One tempering factor to the tail wagging the dog is the number of well-informed scientific and health care bloggers who translate research into lay-language, with a direct reference or link back to original scientific literature. While these bloggers (and I'm one) may not directly influence policy or funding or even research directions, the general increase in awareness amongst consumers I think will gradually have an impact.
My rationale? Only a sector of the community has access to the internet, yet this is one of the simplest ways to obtain readily accessible material. That so many science-literate writers can and do freely give their time to write this material means that for first time ever the general public can get information about science without having to go back to school.
I don't think Web 2.0 will fundamentally change human discourse about health and science. But it does provide another vehicle for information flow, and it's two-way. Already in health practice, informed consumers ask difficult questions. The world is small - in NZ many medications and procedures available in the US are not available, and our consumers ask why. Policy makers are having to consider the question and give a reason. Balance will hopefully come from scientific bloggers providing some level of critical analysis but more importantly, educating consumers about scientific method.
Posted by: Bronnie Thompson | September 25, 2008 1:28 PM | Permalink to Comment
In any business, consumers will always be the driving force. Sadly, there are still any number of places that continue to use 'geek speak' rather than talk in plain language. I think that's one of the biggest challenges facing health 2.0 - speak plainly about complicated subjects.
Posted by: Clara | September 18, 2011 11:26 AM | Permalink to Comment