What if we paid doctors to keep people healthy? | Matthias Müllenbeck

68,723 views ・ 2018-04-18

TED


Please double-click on the English subtitles below to play the video.

00:12
It's 4am in the morning.
0
12936
2007
00:16
I'm waking up in a Boston hotel room
1
16159
2420
00:18
and can only think of one thing:
2
18603
1898
00:21
tooth pain.
3
21992
1150
00:24
One of my ceramic inlays fell off the evening before.
4
24061
2546
00:27
Five hours later, I'm sitting in a dentist's chair.
5
27592
4103
00:31
But instead of having a repair of my inlay so that I can get rid of my pain,
6
31719
4620
00:36
the dentist pitches me on the advantages of a titanium implant surgery.
7
36363
4916
00:42
Ever heard of that?
8
42647
1244
00:43
(Laughter)
9
43915
1361
00:45
It essentially means to replace a damaged tooth
10
45300
3721
00:49
by an artificial one,
11
49045
1711
00:50
that is screwed into your jaw.
12
50780
1889
00:53
Estimated costs for the implant surgery may add up to 10,000 US dollars.
13
53934
4682
00:59
Replacing the ceramic inlay I had before
14
59513
2580
01:02
would come in at 100 US dollars.
15
62117
1933
01:06
Was it my health or the money that could be earned with me
16
66200
3817
01:10
that was the biggest concern for my dentist?
17
70041
2726
01:13
As it turned out, my experience wasn't an isolated case.
18
73966
3437
01:18
A study by a US national newspaper estimated that in the United States,
19
78419
5792
01:24
up to 30 percent of all surgical procedures --
20
84235
3302
01:27
including stent and pacemaker implantations,
21
87561
3556
01:31
hip replacements and uterus removals --
22
91141
3336
01:34
were conducted
23
94501
1151
01:35
although other nonsurgical treatment options had not been fully exploited
24
95676
4173
01:39
by the physician in charge.
25
99873
1570
01:43
Isn't that figure shocking?
26
103320
1538
01:45
Numbers may be slightly different in other countries,
27
105914
2521
01:48
but what it means is that if you go to a doctor in the US,
28
108459
3809
01:52
you have a not-insignificant chance to be subjected to a surgical intervention
29
112292
4872
01:57
without there being an immediate need for it.
30
117188
2333
02:00
Why is this?
31
120632
1150
02:02
Why are some practitioners incentivized to run such unnecessary procedures?
32
122831
4210
02:09
Well, perhaps it is because health care systems themselves
33
129243
5271
02:14
incentivize in a nonideal way
34
134538
2595
02:17
towards applying or not applying certain procedures or treatments.
35
137157
3820
02:21
As most health care systems reimburse practitioners
36
141721
2841
02:24
in a fee-for-service-based fashion
37
144586
2492
02:27
on the number and kind of treatments performed,
38
147102
3674
02:30
it may be this economic incentive that tempts some practitioners
39
150800
3640
02:34
to rather perform high-profit surgical treatments
40
154464
2563
02:37
instead of exploring other treatment options.
41
157051
2698
02:40
Although certain countries started to implement
42
160903
2260
02:43
performance-based reimbursement,
43
163187
2025
02:45
anchored on a quality and efficacy matrix,
44
165236
2866
02:48
overall, there's very little in today's health care systems' architecture
45
168855
3969
02:52
to incentivize practitioners broadly
46
172848
2084
02:54
to actively prevent the appearance of a disease in the first place
47
174956
3592
02:58
and to limit the procedures applied to a patient
48
178572
2562
03:01
to the most effective options.
49
181158
2000
03:03
So how do we fix this?
50
183993
1466
03:07
What it may take is a fundamental redesign
51
187452
2757
03:10
of our health care system's architecture --
52
190233
2172
03:12
a complete rethinking of the incentive structure.
53
192429
2873
03:16
What we may need is a health care system
54
196490
1968
03:18
that reimburses practitioners for keeping their customers healthy
55
198482
4063
03:22
instead of almost only paying for services once people are already sick.
56
202569
4449
03:28
What we may need is a transformation
57
208284
2207
03:31
from today's system that largely cares for the sick,
58
211261
2934
03:34
to a system that cares for the healthy.
59
214903
2600
03:38
To change our current "sick care" approach
60
218545
2881
03:41
into a true "health care" approach.
61
221450
2292
03:44
It is a paradigm shift from treating people once they have become sick
62
224784
4603
03:49
to preserving the health of the healthy before they get sick.
63
229411
3587
03:53
This shift may move the focus of all those involved --
64
233831
3333
03:57
from doctors, to hospitals, to pharmaceutical and medical companies --
65
237546
4857
04:02
on the product that this industry ultimately sells:
66
242427
3377
04:07
health.
67
247006
1150
04:09
Imagine the following.
68
249887
1259
04:12
What if we redesign our health care system
69
252139
2991
04:15
into one that does not reimburse practitioners
70
255154
2858
04:18
for the actual procedures performed on a patient
71
258036
2801
04:20
but rather reimburses doctors, hospitals,
72
260861
3026
04:23
pharmaceutical and medical companies
73
263911
2158
04:26
for every day a single individual is kept healthy
74
266093
2993
04:29
and doesn't develop a disease?
75
269110
1660
04:31
In practical terms, we could, for example,
76
271560
2628
04:34
use public money to pay a health fee to an insurance company
77
274212
4317
04:38
for every day a single individual is kept healthy
78
278553
2503
04:41
and doesn't develop a disease
79
281080
1472
04:42
or doesn't require any other form of acute medical intervention.
80
282576
3762
04:47
If the individual becomes sick,
81
287188
2111
04:49
the insurance company will not receive any further monetary compensation
82
289323
4714
04:54
for the medical interventions required to treat the disease of that individual,
83
294061
4119
04:58
but they would be obliged to pay for every evidence-based treatment option
84
298204
4048
05:02
to return the customer back to health.
85
302276
2364
05:05
Once the customer's healthy again,
86
305825
2128
05:07
the health fee for that individual will be paid again.
87
307977
3079
05:11
In effect, all players in the system
88
311707
2521
05:14
are now responsible for keeping their customers healthy,
89
314252
3500
05:17
and they're incentivized to avoid any unnecessary medical interventions
90
317776
4373
05:22
by simply reducing the number of people that eventually become sick.
91
322173
4756
05:28
The more healthy people there are,
92
328743
2182
05:31
the less the cost to treat the sick will be,
93
331927
2710
05:35
and the higher the economic benefit for all parties being involved
94
335315
3984
05:39
in keeping these individuals healthy is.
95
339323
2666
05:43
This change of the incentive structure shifts, now,
96
343323
2620
05:45
the attention of the complete health care system
97
345967
2261
05:48
away from providing isolated and singular treatment options,
98
348252
4254
05:52
towards a holistic view of what is useful
99
352530
3246
05:55
for an individual to stay healthy and live long.
100
355800
3266
06:00
Now, to effectively preserve health,
101
360545
3881
06:04
people will need to be willing to share their health data
102
364450
3143
06:07
on a constant basis,
103
367617
1508
06:09
so that the health care system understands early enough
104
369149
3087
06:12
if any assistance with regard to their health is needed.
105
372260
3014
06:16
Physical examination,
106
376458
1841
06:18
monitoring of lifetime health data
107
378323
2333
06:20
as well as genetic sequencing, cardiometabolic profiling
108
380680
4302
06:25
and imaging-based technologies
109
385006
2000
06:27
will allow customers to make,
110
387030
1594
06:28
together with health coaches and general practitioners,
111
388648
3381
06:32
optimal and science-guided decisions --
112
392053
2770
06:34
for their diet, their medication and their physical activity --
113
394847
4214
06:39
to diminish their unique probability
114
399085
2584
06:41
to fall sick of an identified, individual high-risk disease.
115
401693
4037
06:47
Artificial intelligence-based data analysis
116
407283
2255
06:49
and the miniaturization of sensor technologies
117
409562
2150
06:51
are already starting to make monitoring of the individual health status possible.
118
411736
4129
06:57
Measuring cardiometabolic parameters by devices like this
119
417118
3236
07:01
or the detection of circulating tumor DNA in your bloodstream
120
421076
3573
07:04
early on after cancer disease onset
121
424673
2325
07:07
are only two examples for such monitoring technologies.
122
427022
2996
07:11
Take cancer.
123
431084
1150
07:13
One of the biggest problems in certain oncological diseases
124
433108
3380
07:16
is that a large number of patients is diagnosed too late
125
436512
4303
07:20
to allow them to be cured,
126
440839
1627
07:22
although the drugs and treatments that could potentially have cured them
127
442490
3389
07:25
are already existing today,
128
445903
1817
07:27
if the disease had only been detected earlier.
129
447744
2488
07:31
New technologies allow now, based on a few milliliters of blood,
130
451109
3976
07:35
to detect the presence of circulating tumor DNA
131
455109
2790
07:37
and thus, the presence of cancer,
132
457923
1718
07:39
early on in a really convenient manner.
133
459665
2367
07:42
The impact that this early-stage detection can have
134
462736
2897
07:46
may be dramatic.
135
466300
1150
07:48
The five-year survival rate for non-small cell lung cancer
136
468893
3653
07:52
when diagnosed at stage one, which is early, is 49 percent.
137
472570
4918
07:58
The same, when diagnosed at stage four, which is late,
138
478792
3825
08:03
is below one percent.
139
483206
1499
08:06
Being potentially able to prevent a large number of deaths
140
486093
4103
08:10
by something as simple as a blood test for circulating tumor DNA
141
490220
5440
08:15
could make certain cancer types a manageable disease,
142
495684
2853
08:18
as disease onset can be detected earlier
143
498561
2818
08:21
and positive treatment outcomes can likely be increased.
144
501403
3277
08:27
In 2012,
145
507593
1380
08:30
50 percent of all Americans had a single chronic disease,
146
510124
4636
08:34
resulting in 86 percent of the $3 trillion US health care budget
147
514784
5388
08:40
being spent for treating such chronic diseases.
148
520196
2362
08:44
Eighty-six percent.
149
524030
2351
08:48
If new technologies allow now to reduce this 86 percent,
150
528919
4447
08:53
why have health care systems not reacted and changed already?
151
533390
3075
08:58
Well, a redesign of what today is a sick care system
152
538159
5575
09:03
into a true health care system that focuses on prevention
153
543758
3938
09:07
and behavioral changes
154
547720
1166
09:08
requires every actor in the system to change.
155
548910
2830
09:12
It requires the political willingness to shift budgets and policies
156
552521
3551
09:16
towards prevention and health education
157
556096
2298
09:18
to design a new set of financial and non-financial incentives.
158
558418
3526
09:22
It requires creating a regulatory framework
159
562902
2652
09:25
for the gathering, using and sharing of personal health data
160
565578
4420
09:30
that's at the same time stringent and sensible.
161
570022
2480
09:33
It needs doctors, hospitals, insurers, pharmaceutical and medical companies
162
573157
4793
09:37
to reframe their approach and, most important,
163
577974
3921
09:41
it can't happen without the willingness and motivation
164
581919
3110
09:45
of individuals to change their lifestyle in a sustained way,
165
585053
4504
09:49
to prioritize staying healthy,
166
589581
2143
09:51
in addition to opening up for sharing the health data on a constant basis.
167
591748
4106
09:56
This change may not come overnight.
168
596668
2123
09:58
But by refocusing the incentives within the health care industry today
169
598815
4580
10:03
to actively keep people healthy,
170
603419
2539
10:05
we may not only be able to prevent more diseases in the first place
171
605982
3881
10:09
but we may also be able to detect the onset of certain preventable diseases
172
609887
3621
10:13
earlier than we do today,
173
613532
1744
10:15
which will lead to longer and healthier lives for more people.
174
615300
3438
10:20
Most of the technologies that we need to initiate that change
175
620136
2870
10:23
are already existing today.
176
623030
1650
10:25
But this is not a technology question.
177
625327
2004
10:27
It is primarily a question of vision
178
627736
2674
10:31
and will.
179
631156
1150
10:33
Thanks a lot.
180
633500
1151
10:34
(Applause)
181
634675
4515
About this website

This site will introduce you to YouTube videos that are useful for learning English. You will see English lessons taught by top-notch teachers from around the world. Double-click on the English subtitles displayed on each video page to play the video from there. The subtitles scroll in sync with the video playback. If you have any comments or requests, please contact us using this contact form.

https://forms.gle/WvT1wiN1qDtmnspy7