Inspired by some questions not asked in health care debate – BizTimes.

Like many, I am concerned about healthcare in America. The above story outlines a number of issues with our system

  • A medical error rate 5 to 9 times higher than some other countries
  • Out of control healthcare costs

The author discusses the fact that Six Sigma has only recently been introduced in American healthcare, and then only on a limited basis. He details a horror story involving his father’s care and decries the fact that such stories abound. From this he concludes that the solution to these problems is…more government involvement in American healthcare.

I’m sorry, but I don’t get the connection. I agree with the above facts and would dearly love to have American healthcare professionals use more process excellence methods, including Six Sigma, Lean, and quality improvement. But I don’t see how more government addresses the root cause of our problems. In fact, I see little or no effort made to drill down to the root cause of the problems in healthcare. Let me make a stab at it.

  • I believe that government programs have contributed to the problem by helping create a disconnect between the patient and the healthcare provider.
  • I believe that the current system limits the choice of patients as to who will provide their care.
  • I believe that patients do not have access to the information they need to adequately assess the quality of their healthcare providers.
  • I believe that special interests (e.g., pharmaceutical companies, medical device companies, insurance companies, professional groups, etc.) manipulate government programs and limit access to information for their own advantage.
  • I believe that political groups use the fear of illness to manipulate voters for the interests of the politicians.
  • I believe that more government control of healthcare would exacerbate the above problems.


I believe that solutions that address the disconnect between the person who provides the healthcare and the person who receives and pays for it will ultimately be needed to fix the problem. This is, I believe, the root cause of our current problems. An ideal solution would be one that:

  • Provides patients with complete, up to date, and accurate information on their provider. This would include information on outcomes, error rates, complaints, etc.
  • Allows patients to choose their care provider.
  • Provides patients with price data in advance.
  • Protects patients from paying for poor quality care, including any problems caused by misdiagnoses, complications from poorly done procedures, infections due to poor practices, etc.
  • Requires patients to pay at least some of the cost of their care directly to the provider. Enough to make the patient care about costs.

In other words, I believe more freedom and more responsibility for patients would address the core problem of the current system. I believe that when patients are free to choose their care provider, have complete information on quality and price, and have a personal interest in the cost of their care, they will make better choices than faceless and nameless bureaucrats employed by insurance companies or the government.

Not to lay the whole blame on government. I believe that the process and quality improvement professions have a great deal to offer the healthcare profession in the form of methods, tools, techniques and systems to improve. But healthcare professionals are overly resistant to such suggestions, at least party because of parochialism and perverse incentives. Examples of perverse incentives include physicians paid to treat complications they either cause or could have prevented, or hospitals obtaining revenues for patients whose length of stay increases because of infections contracted in the hospital. If patients were provided the information they need to make the right choices, the ability to make these choices, and the financial incentive to do so, intransigent providers would either improve or pay the price in the market for health care services. Ultimately, this would drive the demand for the services of quality and process improvement professionals. It’s what did it for every other industry in the world.

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