Why Can’t Medicine Be More Like Uber?

Anyone who has used Uber would probably use terms such as “easy”, “fast”, “simple”, “transparent”, or “cost-effective”. Uber, and for the sake of argument, let’s say other ride share services, allows for people who need a ride and people who can provide that ride a mechanism in a very transparent, open-market system to connect and marry provider and consumer. Through mobile computing, you tell potential Uber drivers where you, where you would like to go, they see you through a pin on the map and you can track their progress to pick you up as well as the suggested route. Estimated fares (costs) are provided up front given the type of Uber (more to follow) and the distance and if there is a premium or “surge” due to supply and demand of drivers for their services. You can choose from basic vehicles and perhaps less-experienced drivers to more premium services perhaps with more modern/spacious vehicles and drivers with more experience or livery service experience. In other words, you can pay for service/quality or opt to pay less and get less. The consumer chooses the driver. And then later rates the driver and the driver rates the passenger as well. All of this is tracked so that the quality of the service, and the customer, have a system in place to rate each other and keep the service mutually beneficial to provider and consumer.

This system is a little bit different than say hailing a cab in a busy city, where the consumer may not know what rating the driver has and fewer standards for cleanliness or “friendliness” of the driver as with Uber, in my experience, and what I have heard from others. Often times there are more fees with a taxi cab that includes a metered fare with some beginning charge as well as time and distance charges.

Uber has been under increasing pressure in some markets so as to not undercut cabs too much with more “service fees” in major cities or pick-ups/drop offs at major airports. Most will still claim that Uber is cheaper with cleaner cars, friendlier drivers and overall better service.

Medicine is of course controlled by a third-party payer system where the insurance company has their interests (keep premiums high and benefit payments low), collectively healthcare organizations, be they hospitals, clinics, free-standing ERs, ACOs, etc… that strive to keep their own costs low and maximize their margins from payments and physicians who want to keep quality high at a fair price. This is greatly over-simplified but for the consumer, the patient, this is the basic construct. They pay their premiums with the expectation themselves or family members will get a high level of care with minimum co-payments/deductibles or other out-of-pocket payments.

Interests for the consumer, the payor, the provider (e.g. hospital) and physician are not necessarily aligned as they are with Uber. There is little transparency, quality measures are difficult to interpret and the provider and consumer often times do not choose each other through a direct payment method and expectation of service that is able to be rated.

This is not to suggest that delivery of healthcare can be compared to ride sharing services but what if parts of it could be more analogous to this model?

What if a provider offered to do a physical examination, or colonoscopy or chest x-ray for a price to offer to consumers, patients?

Imagine if you will, I need a colonoscopy and can use an application to search for endoscopists, what they will charge me that can be paid in cash, some ratings method and an expectation that they will provide me a needed service on a one-to-one basis rather than “needing to qualify”, payor restrictions, high co-pays or deductibles, etc… A more transparent, direct-to-consumer service for both patients and physicians.

Of course some of this exists today with “concierge” type practices where patients agree to a subscription fee and a fee-for-service arrangement payable to the physician for each transaction. You can extend these direct to consumer model for a wider range of services and whether you need an endopscopy, imaging study, want to see someone about a sore ankle or sore throat, essentially select a provider based on what he/she costs and is willing to accept to provide you that service which may also allow for some “pay for quality” much as one does with selecting UberBlack or UberSelect over UberX, in this analogy.

Depending on what kind of experience you have, you can rate the physician and this can be used to determine if the fee is fair value for the level of service/experience. And perhaps even physicians can rate patients!

So when you go to your next UberPhysician he/she can decide if they want to enter into a business transaction with you.

And the patient-consumer has more control over their own healthcare and healthcare expenditures and experiences.