Saturday, September 15, 2007

Ethically Admirable Health Care Competition

We in the U.S. pride ourselves on religious diversity, but in truth we have a national religion – market economics. We worship markets with the fervor of fundamentalists. We treat ideas like “competition is the best way to drive improvement” as sacred truths, not hypotheses.

Unfortunately, health care competition often drives a race to the bottom. Hospitals jettison medically important but unprofitable “service lines.” Insurers cherry-pick enrollees. Medical students abandon primary care and flock to plastic surgery and other lucrative specialties.

Today’s New York Times has a story about Cincinnati Children’s Hospital Medical Center that shows the bright side of competition. Six years ago when Cincinnati Children’s concluded it needed a new strategy it decided to specialize in niche areas where novel approaches to care were needed. It has developed special expertise in treating Fanconi anemia, a serious but rare genetic disorder, and reports that it treats one third of the 300 Fanconi patients in the U.S. Similarly, it has developed a distinctive colorectal program which its website describes as “the first and only pediatric colorectal center in the world!”

Cincinnati Children’s strategy is paying off for the bottom line as well as for improved population health. The strategy marries medical ideals – caring for the sick in a high quality manner – with shrewd program choices. Health care is a calling, and this is the right kind of competition.

Competition is an important part of a national strategy for improving health care. But sustaining and nourishing the structures and values that make health care a calling is more important.

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