Review of Getting Health Reform Right

I was excited to read Getting Health Reform Right because it approached the problem of health care reform from an international, public policy perspective. The authors all have deep experience working internationally to address health care, and that shows throughout their analysis in the many real world examples of reforms gone right and wrong drawn from across the globe.

Oblique influence

I just finished a long section of Getting Health Reform Right about the role of regulation in health care that was, to say the least, eye-opening. And as usual, I want to leave aside discussions of health reform and talk more about the implications for leadership generally.

My biggest take away was that changes in health care can rarely be legislated directly: if you want to lower the costs of services, it’s not feasible to just mandate lower costs; if you want more people to seek preventative care, you can’t make a law that they do so; if you want better providers in under-served communities, you can’t just tell them to go there. This kind of direct approach will ultimately fail, either because the link between cause and effect is too complex or because compliance with the law is difficult to enforce.

Make sure you tie your carrot to a stick

I’m still finishing up Getting Health Reform Right, so a review is a week or so off. But in the meantime, I came across this passage on the plane last night and thought it held wonderful insight into leadership generally.

“Changes in external incentives and in internal management are powerfully complementary. Giving managers incentives without also giving them the skills, authority, and resources they need to respond to those incentives is likely to be quite ineffectual. The same is true in reverse. Increased managerial authority is not likely to lead to improved care if managers have no incentive to do so. This is why various writers on organizational reform in health care have seen a need for “consistent” change (Harding and Preker 2002). It is not aesthetics that lies behind their observations, but rather the need to combine reasons to do better with this capacity to do better–in the same reform package.” (Getting Health Reform Right, p. 215)

Leadership and the feasible

Although I’m still only early on in Getting Health Reform Right, there’s food for thought in every section. The following quote is from their chapter on the politics of reform, and although the political context of health care reform (particularly in third world countries) is an animal unto itself, this quote got me thinking about what makes a successful first-world corporate leader.

Talented political leaders, like talented generals, can win battles and campaigns that would overwhelm those less able or less energetic. So, asking if a policy is feasible is, in part, asking a question about the advocates of reform, especially their creativity, commitment, and skills—and about their opponents. (Getting Health Reform Right, p. 6)

The execution cycle

I’ve cracked the next book in my quest to better understand the health care problems facing the U.S.: Getting Health Reform Right, by Roberts, Hsiao, Berman, and Reich. This is another long one, so a dedicate review is a ways off, but I came across an interesting framework in the opening chapters, one that, with some slight changes in emphasis, could have applicability beyond government policy to include corporate decision-making.