Damn, I was hoping I was the first person to write on decentralization in healthcare. Seems like everyone else has beaten me to it.
In this article, I’ll discuss how healthcare could benefit from decentralization and what’s in it for a physician who might want to do something in this space.
Whether you want to be a healthcare consultant – which is much easier than it sounds – or create digital products for healthcare entities, there are many opportunities in this space.
Decentralization
Wiki does a great job explaining it. And in fact, Wiki is a decentralized source of information. Everyone gets to make edits to the vast amount of knowledge in existence.
Taking power away from a centralized system can make it more equitable for others to have fair access within that system.
But decentralizing healthcare, for example, can also take pressure off the system. If the centralized system is overwhelmed and underperforming, then dispersing the services among other arms could be a great solution.
The Potential of Decentralized Systems
Airbnb and Starlink are such examples. Local food production and local manufacturing of goods are other ways decentralization has evolved in this globalized world. Though deglobalization is catapulting decentralization forward.
The backbone of all this comes from the lack of faith people have in governments. As politicians continue to push laws that benefit them and their rich buddies, the poor are left with less representation.
Is a village poor if they can produce all of their own produce? If they can pay for the entire town to purchase a piece of the Starlink connection? If they can put up their own solar panels and construct energy efficient homes?
Could a village fall into poverty if the people have access to untainted health information and can handle 95% of their healthcare needs?
Decentralized Healthcare
Requiring the FDA to approve a drug and then trusting that the research it’s built on is legit requires a lot of faith in the system. And some might say that maybe the rewards of this trust haven’t panned out as much.
If the hospital groups are powerful enough to lobby for the self-fulfilling legislature, you don’t “take part” in the inpatient healthcare system but become the victim.
In a decentralized healthcare system, any doctor can turn your bedroom into a hospital. Or any hospitalist can turn a shack into an ICU.
Decentralized Healthcare Research
Current model: torture and kill a bunch of rats using chemical X and come up with some bullshit assumptions. Take chemical X and design 100 studies and publish only the 2 studies which showed that chemical X had a desirable outcome in human subjects.
Then have the pharma fund other studies like it until you have 30 such studies. All you need now is a meta-analysis of all these garbage studies to show that chemical X can, in fact, help you live 36 seconds longer.
Decentralized healthcare research model: allow all willing humans to make their health data available and rent it out or sell it. Then mark those who lived 36 seconds longer and use the accumulated data to figure out what lifestyle or possibly even environmental chemical could have led to this longevity.
Decentralized Pharmaceutical Care
Designing a chemical takes work, but copying a compound is not hard. How else do you think a brand-name drug goes to generic?
There is no magic when it comes to the chemical structure of amoxicillin. You can isolate your own penicillin, even.
If you do this as a business entity, you infringe on patent laws – illegal. Healthcare patent law is a useless, backward vestige brought over from other underperforming economic sectors.
The Physician Expert in Decentralization
As always, I try to talk about things in healthcare that are either underrepresented or up-and-coming.
As a physician, you understand how the different pieces of the healthcare puzzle fit together. If you don’t, great resources are available to better understand the current healthcare paradigm.
Once you know how it functions, you can apply that knowledge to healthcare decentralization. Your expertise will be simply on commentary and observations. The cool kids call this a think tank for it.
1. Patient Data
Just the topic of patient data has so many branches. Too many to mention here.
From who should own patient data to how it should be regulated and how it can be made accessible. Lots to talk about.
2. Oversight & Credentialing
Who will be responsible for credentialing these structures and services when you build standalone hospitals or ICUs?
Can the actual credentialing and oversight be decentralized, so automated quality metrics are built in?
3. Medication Shipping
From medication vending machines to automated medication shipping, what’s the pharmacist’s role and interstate transit?
In a decentralized healthcare system, should a pharmacist be involved, and should it be for patient education or dispensing medications?
5. Research Design
With free-flowing patient data, how can this be captured for monitoring treatments and providing real-time feedback?
How does a principal investigator work in this new system to interpret research data live, instead of 5 years after it’s all been collected?
By the way, traditional research died a long time ago. Anyone can publish nearly anything to prove whatever they like.
6. 3D Printing Rx
Chemical reactions are easier than ever before, and computers can handle most of the mixing.
How can 3D printers provide consumers with brand or generic medications on demand?
7. Standalone Inpatient Care
I doubt we just witnessed our last pandemic. A hospital-based system isn’t feasible.
How can we build standalone ERs, ICUs, and inpatient units?
8. International Care
Decentralized healthcare should not depend only on local care. If the pieces of the whole are managed individually, then I should be able to get the same care in Greece as in NY.
Perhaps globalization will see a major decline over the next few years, but travel likely won’t change much. People across borders will continue to need care that’s culturally and financially appropriate for them.
9. Home Care
The safest space for many is in their own home. Data collection is easier, and care delivery can be more predictable.
It’s not cost that’s a hindrance but outdated legislature.
10. Wearable Technology
This is part of the patient data discussion. How can the patient’s health be independently assessed without input from the physician?
I am happy to oversee the care of someone, but I can’t do it if they tell me they eat salads all day and exercise regularly. When, in fact, they are the Cheetos and Netflix type.
11. Insurance Coverage
I don’t want to submit a claim to Medicare and wait 3 months for payment. The patient comes in for a UTI, and the UA confirms it, and they picked up the Nitrofurantoin.
With enough points in the system to prove a complete triangle, reimbursement should be automated.
12. Remote Patient Monitoring
This, again, is the continuation of the data conversation. True, right now, we hardly trust the government to know our Social Security Numbers. But at some point, we need data to make a meaningful impact on health.
13. Virtual Care
We are still using an abacus instead of a keyboard in healthcare. Technology has sufficiently advanced, but interacting with it is dated.
Virtual care needs a full redesign. Taking the brick-and-mortar practice and doing it online defeats the purpose of using technology.
14. Medical Education Redesign
Without understanding data and virtual care, the modern doctor won’t be well-equipped to be a positive patient decision-maker.
The systems in healthcare maximize profits. A decentralized healthcare system must maximize health.