Peter Ubel author of Free Market Madness, was today’s second keynote speaker and challenged the idea that an empowered and education consumer is always a good thing.

Ubel started out by posing the question if the idea of a free market, where increased demand for a product or a service causes costs to fall and the quality levels increase, could be applied to the healthcare industry.

However, one of the challenges is that humans are typically flawed decision makers and prone to poor judgement. He illustrated this with an example of where patients, who were educated about the relatively low risk of developing a particular cancer, were less likely to choose to have the regular tests for early detection. He believes that this is also true of clinicians, who are also likely to make irrational decisions. If something is new, expensive and scarce then doctors will likely choose it as the belief is that it must be better than something already on the market.  Could this be one of the reasons for the spiralling cost of healthcare delivery?

All of us, whether patients or doctors, make decisions based not just on available information, but also under the influence of unconscious factors, and this has implications for healthcare policy makers. He made four key points:

-          You can’t expect the free market to solve everything as there are lots of unconscious factors influencing outcomes

-          We must move beyond comprehension alone – education does not solve the issue

-          Persuasion should be used appropriately with honest labelling and through social marketing

-          Utilise financial incentives by taxing unhealthy foods and subsidizing healthy food or fitness centres

Ubel concluded by stating that all of this must be done by balancing freedom and well-being, and by helping markets to do what they do best and restrain them from what they do worst.

It was a whirlwind tour through some interesting research but certainly a topic worthy of further reading.

As part of a futurist session today, at the Partners Connected Health Symposium, Tandy Tower from Microsoft Robotics, proposed an idea that assistive care robots could become common place in many homes within the next 3-5 years. These robots would be developed in response the ageing demographics that are evident across the world and to address the shortage of caregivers available to meet the needs of this section of the population.

These robotic nurses or home care assistants, would be able to help with medication reminders, allow medical peripherals to be connected, support video consultations with a clinician and deliver social interaction opportunities with other people in a network. Another idea proposed was that these robots could help with coaching and rehabilitation therapy for patients who have suffered a stroke.

Tower believes that this technology could be available for less than $5000 but I don’t believe that cost will be the main barrier to deployment and adoption. A bigger challenge, in my opinion, will be the acceptance of a robotic humanoid moving around your home and constantly checking up on your actions. Would you have a robonurse in your home?

Over the next two days, I’ll be blogging from the 2009 Connected Health Symposium, run by Partners Healthcare Center for Connected Health, in Boston.

The opening keynote at this year’s symposium was delivered by Stuart Altman, Professor of National Health Policy at Brandeis University, who spoke on the topic of healthcare reform and some of the challenges it brings.

In 1971, US spending on healthcare delivery was $75 billion, or 7.5% of GDP but today this has reached $2.5 trillion or approximately 17% of GDP. Many people have tried to address this for years but 3 clear issues have emerged that need to be addressed:

1)      Create a universal healthcare financing system

2)      Develop programmes to reduce the rate of growth in healthcare spending

3)      Improve the quality of care delivered

The current political discussions in the US try to address these issues and will likely reduce the overall federal spend but spend from other sectors may increase. These would include increased spending by states and increased payments for insurance by younger people.

Professor Altman then introduced what he called Altman’s Law: almost every powerful constituent group favours health reform but, if it is not their plan, they prefer the status quo. In the case of the current reform, the industry to see most negative impact will be the Insurance Companies – all other stakeholder groups will either get additional funding or stay the same, making it easier for the reform to succeed.

In conclusion he stated the need to change the payment and delivery system, through an appropriate but effective comparative effectiveness system that includes clinical and cost effectiveness components.