Review of Redefining Health Care, by Porter and Teisberg

Looking back through my records, it appears that I began Porter and Tesiberg’s Redefining Health Care last November, so it’s a bit embarrassing that I’ve only now, in March, managed to finish it. In my defense, about halfway through it, I left it on a plane, and that initiated a bit of an odyssey to get it back, but really it’s just a long book and I’ve gotten a bit sidetracked with other books over the last two months. But enough excuses…

Overall, this is what you would expect from a project Porter was involved in: strong theory and lots of real world examples brought together into a framework that, if you accept the premises, is air tight.

The basic outlines of their take on health care is that competition in health care currently happens at the wrong level to encourage the competition and innovation needed to deliver higher value and lower costs. On the one hand, it occurs too broadly, at the level of providers, health plans (aka health payers), physician groups, networks, and hospital groups. On the other, it occurs too narrowly, at the level of discrete medical procedures like diagnostic imaging, anesthesia, or physical/occupational therapy.

In both of these cases, they argue, the competition fails to deliver value to patients, which should be the primary goal of the health care system.

Instead, Porter and Teisberg suggest that the proper competition in health care should take place at what they call the medical condition level, i.e., a set of patient health circumstances that benefit from dedicated, coordinated care (e.g., asthma, heat disease, broken leg).

Rather than rehash their arguments in detail (you can get a good overview at the companion website to the book), I want to talk a bit about my take on the book, because I found myself having a mixed reaction to it.

On the whole, I found this be a worthwhile book with an important perspective on the problems facing the health care system in the U.S. Definitely a must read for anyone looking to get a better understanding of the issue (or even those who are interested in learning more about how Porter views competition).

That having been said, the book could have easily been half as long without compromising the strength of the arguments–in fact, it may have made them stronger by tightening up the presentation a bit. Somewhere in the middle of the book you realize that there’s nothing new coming your way and what’s left is going to be the same ideas presented from slightly different perspectives (effect on payers vs. providers vs. the government, etc.) for the remaining 200+ pages.

Related to that, I also found myself wondering whether Porter and Teisberg were trying to apply a model of competition to health care that maybe isn’t the best fit for it. It’s the old, when you have a hammer, everything looks like a nail problem. The kind of competition they describe in the book has worked in lots of other industries, I get that. But even after 400+ pages, I was left with a nagging doubt about whether it would in fact work in health care.

If you find a way to improve the value chain for a particular widget and operationalize that, you will outpace the folks who don’t. But, as Porter and Teisberg (and lots of others) freely admit, health care in the U.S. doesn’t seem to currently function according to typical laws of competition we see in other industries. Leaving aside the reasons for this (which lots of folks disagree on), the fact that it’s the case makes me skeptical that the expected effects of typical competition on their own will transform health care.

It’s the same kind of doubts I had after finishing Christensen’s book: the problems facing the health care system in the U.S. seem to intractable and to dire to simply let the marketplace seek its own level.

Anyway, that’s my two cents–would love to hear what others think of the book…and in the meantime, on to the next one!

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