Review of The Innovator’s Prescription, by Clayton M. Christensen

So, at long last, I’ve finished The Innovator’s Prescription by Clayton Christensen. This was a bit of a slog, but worth it. In every section, Christensen delivers solid ideas and compelling frameworks to understand and address some of the main problems facing health care in the U.S. I definitely recommend it to anyone looking to dig in more deeply to this issue.

Because I’ve already written quite a bit about this book over the last few weeks, I’ll try not to recycle too much here, but focus instead on my overall impression and thoughts on Christensen’s work. Folks interested in a deeper dive can look through these earlier posts to see my thoughts on this book as I was reading it.

For starters, Christensen’s take is definitely very different from T.R. Reid’s in The Healing of America. For Reid, fixing health care in the U.S. needs to begin with the moral decision that health care is a right not a privilege–everything else we need to do to fix health care flows from here.

Christensen, although he has a very strong, very public commitment to high moral standards, leaves morality out of his analysis almost entirely. For him, health care is a business no different from others that have transformed from expensive, centralized offerings to affordable, localized ones such as the theater, music, telephony, and computing.

The key is to enable the disruptive innovation that drives costs down and accessibility up, just like in other industries: the telephone disrupted Western Union offices to make communication less expensive and easier to access, and cell phones returned the favor by disrupting telephones in their turn; microcomputers disrupted mainframes and were themselves disrupted by PCs (which are now being disrupted by smartphones and tablets).

In health care, Christensen predicts, general hospitals will be disrupted by specialty providers focused on single procedures (like angioplasty or organ transplants), specialty providers will themselves be disrupted by general practitioners, general practitioners will be disrupted in turn by nurse practitioners and doc in the box type services, and nurse practitioners and doc in the box services will be disrupted by online communities of care and automated self-service tools.

All this, for Christensen, is the way every industry lowers cost and increases accessibility–health care will be no different. Most government intervention and regulation, in his opinion, has historically served only to slow the progress of disruption, so he is bearish on the government’s role in all this.

In the end, I have mixed feelings about Christensen’s take on health care. On the one hand, I completely agree with his model of disruption and can see how it will radically transform the delivery of health care in the U.S. But to me, there is definitely a moral dimension to the problem, one that compels us to act more quickly than the typical pace of disruption (which he predicts will be in roughly 25-year waves).

When you consider that approximately 22,000 people will die in 2010 from easily preventable diseases, letting the market follow its own course of disruption seems unconscionable. Health care is, on some level, fundamentally different from building a widget. After all, whether or not we get easier access to tablet PCs is not a matter of life and death, but whether kids below the poverty line get preventative treatment for asthma is.

Having not read the health care reform bill, I can’t say whether I think it’s the answer, but I do think that the government could play an important role in speeding up the process of disruption that Christensen outlines in his book…although I need to think more on this subject before I would venture a guess as to how.

Anyway, this was a challenging, thought-provoking book that I recommend highly. Any of you out there read it? Thoughts on Christensen’s view? Thoughts on my thoughts on Christensen’s view? Jump in and let everyone know what’s on your mind, and let’s get the conversation started.


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