In my younger years, I would visit my grandparents in Florida. In their garage, they had an old white Toyota Corolla. Although the car is quite old, it has remained in good condition. After all, it was only 300 miles away. Not 300,000 miles – no comma needed – just the equivalent of one full trip from Jacksonville to Miami on the odometer. My grandparents booked the car specifically to visit family “to drive.” These quotes are important.
When I was of driving age, my grandmother—now in her 80s and set in the back, with two cataracts to her credit—made generous inputs and colorful comments on my car. I made it a point to indicate that I should not follow too closely the car in front of me. However, I didn’t let the car in my ass follow me closely either. I was told, in no uncertain terms, that I must always speed up and slow down, at the same time.
This puzzle presented itself again on one particularly memorable trip down I-95 I was stuck between decelerating to give more distance to the car in front of me, and accelerating to lengthen the distance away from the car behind me. If you choose not to do either of these things, or not to do either of the above? I would have carefully chosen my grandmother’s wrath. If you knew her, you’d know I don’t want that anger. Nor are you.
So while I was at the wheel, I sure didn’t feel like it. This colorful anecdote draws an important parallel to how we experience, deliver, and engage with the healthcare system. For many patients who drive their own health journeys, this lack of control mixed with confusing advice must be eerily similar to fraught driving with frantic passengers luring shots.
Who leads health care?
Driving change in the health sector is challenging precisely because no one can seem to agree on who is driving who, when, or where. In theory, the ecosystem is set up to benefit the patient first. When we think of patient-centered care, we like to imagine them in the driver’s seat for their health.
However, our current model of care delivery operates more like a bus where everyone gives directions, tells the patient how to drive, and where to stop or get off, often with contradictory input. Some demand the fastest route, some avoid (or encourage) tolls, others ask patients to take only the routes familiar to them… speed up, slow down, turn here, walk in a straight line, drive on shoulders and avoid all that traffic.
The question of who leads health care is not easy to answer, nor is it always answered in the way that best serves the person who leads the care. Back-seat drivers cannot agree, take turns steering and dictating directions (not in a small part in the service of their own interests) and ultimately leave patients unable to drive with enough confidence or knowledge. This is a written illustration of the principal agent problem, which, although it does not arise from and is not limited to health care, this problem is particularly evident.
Examples of principal agent problem(s)
When priorities differ between a person or entity who can make decisions or take action (the “agent”) on behalf of (or such influence) another (the “manager”), this creates a moral hazard. In the delivery of care, since the patient is clearly responsible, this can also lead to potential health risks. The scope of the principal agent problem is as broad and severe as the size of the system and the diversity of factors.
There is a wide variety of people and entities that are beholden to diverse interests, incentives, and obligations, and routinely make decisions on behalf of patients. These factors fall mostly into three main categories: Payers, providers, and caregivers.
my motivation Covering patient care costs, but every dollar spent means less money for shareholders. To the extent they see fit and to the extent permitted within legal limits and compliance, payers can maximize profits by refusing to pay patient care payments.
savers Work to make the patient healthier, but must also comply with regulatory, legal and ethical mandates, and work within budget and administrative constraints. They must also work to ensure that they can continue to earn a living to support themselves and their families and the infrastructure to provide care (eg staff, technology, licensing and overhead).
caregivers She wants to improve the patient’s health as well, but she also has a huge emotional investment in the patient’s journey. The desired outcome for the caregiver or the means of getting there may differ significantly from the patient’s outcome. For example, if antibiotics reduce the length of time a child has an ear infection by 24 hours, but increase the risk of diarrhea and other unpleasant side effects, what the caregiver chooses may vary depending on the severity of the infection, and who the caregiver should choose. do that. Change diapers and who has to wake up at night with the crying baby.
Solutions (and directions) to navigate the way forward
a 2011 analysis تحليل Examination of the prescribing patterns of private providers in Viet Nam suggests that empowering patients with greater education may help reduce the primary agent problem in health care. The more a patient knows about their health and how health care works, the more confident they are while advocating for themselves, and the more likely they are to weigh all treatment or prevention options appropriately, or to refuse unnecessary treatment.
The analysis also suggests improving regulatory oversight and collaboration between the public and private sectors to better align provider incentives and payer with patients’ interests, echoing research from Tennessee State University Posted a decade ago.
The stimulus, of course, remains the invisible hand on the wheel. To increase the balance of measures of input between patients and agents, 2012 show In the Fourth International Scientific Conference He proposes a payment system designed to “contribute as much as possible to the clinician’s motivation to maximize patient benefit”.
The benefit-based reward system should, by its nature, stimulate optimal consumption of resources. Optimal finds the sweet spot between today’s dual systemic ills of ruthless efficiency and redundant excesses. Care can focus more directly on patients’ interests when the system resets their incentives—financial, organizational, professional, and emotional—to align more closely with patient outcomes.
Empowering patients to take charge
To drive advances in healthcare means, as often and as expertly as possible, to help patients Leadership Instead of “driving”. This requires patient focus and protection of sacred trust in the patient-provider relationship. The principal-agent problem, even if not directly caused by the providers themselves, erodes that trust. Payers, caregivers, service providers, and the larger healthcare ecosystem all play a role in aligning with what is best for the patient and valuing their trust above all.
The easiest way to get a patient to take the wheel of their health journey is to remind them at every turn that they are the driver and provide them with education, trust, transparency and support to keep their eyes on the road and their desired destination within easy reach. The less driving in the back seat, the more likely patients are to listen to vital inputs or discover things for themselves.
Otherwise they would end up like I did, on I-95 in Florida, with my grandmother sitting in the back of the Corolla. That day, torn between speeding up and slowing down, but expecting to do both, I thought I’d found a very clever way out: I pointed at the mirror, then signaled to her that the car behind us wasn’t close.
But my grandmother was not so easily deceived, for the rear view clearly stated, “Things in the mirror are closer than they appear.”
She said, “Oh, it’s even worst than I thought. You’d better change lanes.”
Definitely. Now, why didn’t you? I Think about it? After all, I He was the one driving.
Photo: Boogich, Getty Images