The U.S. health care system is in crisis. At stake are the quality of care for millions of Americans and the financial well-being of individuals and employers squeezed by skyrocketing costs - not to mention the stability of state and federal government budgets. In "Redefining Health Care", internationally renowned strategy expert Michael E. Porter and innovation expert Elizabeth Olmsted Teisberg reveal the underlying and largely overlooked causes of the problem and provide a powerful prescription for change. The authors argue that participants in the health care system have competed to shift costs, accumulate bargaining power, and restrict services rather than create value for patients. This zero-sum competition takes place at the wrong level - among health plans, networks, and hospitals - rather than where it matters most: in the diagnosis, treatment, and prevention of specific health conditions. In spite of competition among these systems, the patient care cycle is poorly coordinated. The fractured system undermines both efficiency and quality of outcomes. "Redefining Health Care" lays out a breakthrough framework for redefining health care competition based on patient value over the full cycle of care - from prevention and diagnosis through recovery or long-term disease management. With specific recommendations for hospitals, doctors, health plans, employers, and policy makers, this book shows how to move to value-based competition on results that will unleash stunning improvements in quality and efficiency.
Redefining Health Care
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"...a profound and powerful critique of America’s health-care system. It deserves to be read widely. And probably will be." -- Economist.com
About the Author
Michael Porter acts as one of the World Economic Forum's Global Competitiveness Report's primary editors.
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Michael E. Porter, Professor of Business Administration at the Harvard Business School, is the author of Competitive Strategy, the recipient of the 1979 McKinsey Foundation Award for The Best Harvard Business Review Article, and a guest columnist for the Wall Street Journal. Professor Porter developed the much praised MBA course on Industry and Competitive Analysis, lectures widely on competitive strategy, and is a strategic consultant to numerous companies in the United States and abroad.
Customer Reviews
Most Helpful Customer Reviews
40 of 48 people found the following review helpful
Format:Hardcover
Porter's theories on management are the bread-and-butter of management theory but he knows little about healthcare. It would be fantastic if his elegant theories worked for this industry, but they don't.
Serious flaws:
Authors: Care value should be measured by outcomes.
Reality: This is the fundamental problem with the healthcare market is that even the end-user of cannot fully assess the outcome not to mention the medical interventions' contributions to that outcome. Diseases recur and response to medical treatment varies so greatly that doctors rarely agree on the simplest courses of treatment. Only for the most common disease states will there be consensus on intervention. The authors compare the healthcare consumer to the institutional purchaser of computer systems, people that are generally IT experts. This is akin to comparing all patients to nurses.
Authors: Competition should exist at a national level.
Reality: Patients are cured locally because sick, pregnant, working people, etc., do not want to travel to another city to get specialized care. In fact, Guy David's studies show that proximity of less than half a mile holds more sway for patients than expertise. One can't purchase healthcare over the internet. Nor can patients in the bottom 50% of wage-earners travel to another metropolitan area every month to see a field expert.
Authors: Community-based hospitals repeatedly produce better outcomes than academic institutions
Reality: Patients with difficult-to-treat medical conditions are referred to or self-refer to academic medical centers so the sample group is biased.
It's no surprise that Porter missed some of the most obvious aspects of defining the problem. The acknowledgements section of the book contains few of the renowned experts in the field. The centers of knowledge do not lie in the management departments of Harvard or Darden. The authors seem to only have corroborated their theories with individuals from other industries, second-rate scholars, and politicians.
It was frustrating to have to read 411 pages of repetitive and ignorant text. While Porter has created groundbreaking theories in management (specifically of manufacturing and less-specialized service industries) he is attempting to fit his famous theories where they do not fit.
One must admire the attempt to write a comprehensive solution to the problem of the US healthcare system. However, it's an effort fraught with laziness and little introspection. The book, however, has a decent reference section. Either the authors did not read these papers themselves or chose to ignore the most salient points in the works of the field experts. If you want to real scoop, read Halvorson, Pauly, Danzon, Fisher, or anyone else who has studied this field for more than the authors' seven years.
Halvorson's Health Care Reform Now is a far superior book because it provides actionable remedies for the health care problem. Furthermore, Halvorson has 30 years of healthcare experience (compared to Porter's 3 years when he wrote this book). In addition, Halvorson has actually implemented his suggestions. Also, he cites credible organizations and publications that actually support his suggestions (RAND, IOM) whereas Porter cites and collaborates with organizations merely willing to collaborate with him (Dartmouth and Harvard - two institutions with very little research and health care specialists).
Halvorson's book may not have as thick a list of citations as Porter's; however, it makes its point more concisely and much more effectively than Porter's.
In Porter's defense, since writing this book, he has become more knowledgeable about health care and his arguments are starting to make more sense. Redefining Healthcare proves the complexity of health care by demonstrating how difficult it is to apply basic theories of other industries to fix the health care system.
Halvorson's book along with R. Lawton Burn's The Business of Healthcare Innovation are the two most valuable books on the American health care system. You can read them both in half the time it will take you to read Redefining Healthcare and you will be twice as knowledgeable.
Serious flaws:
Authors: Care value should be measured by outcomes.
Reality: This is the fundamental problem with the healthcare market is that even the end-user of cannot fully assess the outcome not to mention the medical interventions' contributions to that outcome. Diseases recur and response to medical treatment varies so greatly that doctors rarely agree on the simplest courses of treatment. Only for the most common disease states will there be consensus on intervention. The authors compare the healthcare consumer to the institutional purchaser of computer systems, people that are generally IT experts. This is akin to comparing all patients to nurses.
Authors: Competition should exist at a national level.
Reality: Patients are cured locally because sick, pregnant, working people, etc., do not want to travel to another city to get specialized care. In fact, Guy David's studies show that proximity of less than half a mile holds more sway for patients than expertise. One can't purchase healthcare over the internet. Nor can patients in the bottom 50% of wage-earners travel to another metropolitan area every month to see a field expert.
Authors: Community-based hospitals repeatedly produce better outcomes than academic institutions
Reality: Patients with difficult-to-treat medical conditions are referred to or self-refer to academic medical centers so the sample group is biased.
It's no surprise that Porter missed some of the most obvious aspects of defining the problem. The acknowledgements section of the book contains few of the renowned experts in the field. The centers of knowledge do not lie in the management departments of Harvard or Darden. The authors seem to only have corroborated their theories with individuals from other industries, second-rate scholars, and politicians.
It was frustrating to have to read 411 pages of repetitive and ignorant text. While Porter has created groundbreaking theories in management (specifically of manufacturing and less-specialized service industries) he is attempting to fit his famous theories where they do not fit.
One must admire the attempt to write a comprehensive solution to the problem of the US healthcare system. However, it's an effort fraught with laziness and little introspection. The book, however, has a decent reference section. Either the authors did not read these papers themselves or chose to ignore the most salient points in the works of the field experts. If you want to real scoop, read Halvorson, Pauly, Danzon, Fisher, or anyone else who has studied this field for more than the authors' seven years.
Halvorson's Health Care Reform Now is a far superior book because it provides actionable remedies for the health care problem. Furthermore, Halvorson has 30 years of healthcare experience (compared to Porter's 3 years when he wrote this book). In addition, Halvorson has actually implemented his suggestions. Also, he cites credible organizations and publications that actually support his suggestions (RAND, IOM) whereas Porter cites and collaborates with organizations merely willing to collaborate with him (Dartmouth and Harvard - two institutions with very little research and health care specialists).
Halvorson's book may not have as thick a list of citations as Porter's; however, it makes its point more concisely and much more effectively than Porter's.
In Porter's defense, since writing this book, he has become more knowledgeable about health care and his arguments are starting to make more sense. Redefining Healthcare proves the complexity of health care by demonstrating how difficult it is to apply basic theories of other industries to fix the health care system.
Halvorson's book along with R. Lawton Burn's The Business of Healthcare Innovation are the two most valuable books on the American health care system. You can read them both in half the time it will take you to read Redefining Healthcare and you will be twice as knowledgeable.
11 of 14 people found the following review helpful
Format:Hardcover|Amazon Verified Purchase
"Redefining Health Care" begins with data detailing the failures of America's "health system" - the highest and most rapidly rising costs among modern nations, combined with millions of uninsured, high error rates, and an average 17 years for the results of clinical trials to become standard clinical practice. Thus, the puzzle: "Why is competition failing in health care?"
Porter and Teisberg's answer is that it focuses far too much on cost-reduction, increasing negotiating power, providing broad-lines of service, and cost-shifting, and instead should focus on long-term value (results vs. costs) for patients. Key to accomplishing this is the collection of standardized patient outcome data (preferably risk-adjusted) that are used to identify providers needing improvement and sources from which that improvement can be gleaned, as well as in guiding patient decision-making.
"Redefining Health Care" also asserts that its recommendations are not just theories, but also supported by a number of cited examples.
This book provides a clear vision of how the U.S. can reduce health care costs while improving patient outcomes - without increased complexity. It should be read by legislators at both the state and national level, as well as by health care providers.
Porter and Teisberg's answer is that it focuses far too much on cost-reduction, increasing negotiating power, providing broad-lines of service, and cost-shifting, and instead should focus on long-term value (results vs. costs) for patients. Key to accomplishing this is the collection of standardized patient outcome data (preferably risk-adjusted) that are used to identify providers needing improvement and sources from which that improvement can be gleaned, as well as in guiding patient decision-making.
"Redefining Health Care" also asserts that its recommendations are not just theories, but also supported by a number of cited examples.
This book provides a clear vision of how the U.S. can reduce health care costs while improving patient outcomes - without increased complexity. It should be read by legislators at both the state and national level, as well as by health care providers.
25 of 34 people found the following review helpful
Format:Hardcover
Health care reform is a critical issue. The authors are well-known, highly educated, and know their subject well. Unfortunately, they wrote a book whose redundancies, especially in the opening chapters, drives the reader to boredom. Likewise, the reader feels at times as though the good professors were trying to fulfil a mandatory page count, and therefore, inserted much irrelavant data. Frankly, I set the book aside, planning on finishing it after more readable books have been read.
Most Recent Customer Reviews
Michael Porter is masterful
Michael Porter is masterful in using his corporate strategic management techniques and applying them to healthcare. Read more
Published 1 month ago by John B
For a class paper...
Bought for a class assignment on health care system and ways to change the status quo. Had relevant data for my paper. Came in good condition.
Published 5 months ago by andrea
Very Insightful
A very insightful book that all hospital system professionals should read; particularly those in finance and management. Read more
Published 8 months ago by J. Rowe
book
I purchased this book to assist me in writing a paper for college. It was very helpful and informative
Published 16 months ago by Pam
Couldn't Disagree More
I respectfully disagree with the conclusions and recommendations outlined by Dr. Porter. He discusses the need to increase "value" in our healthcare delivery system. Read more
Published 20 months ago by John J. Healey
Redifining Health Care
The book is in excellent condition, but it took a long time to get mailed to me.
Published 22 months ago by Heather M. Tonga
What's wrong with the US health care market place?
Why doesn't it follow the progression to higher quality and lower prices as most other industries do? Read more
Published 22 months ago by Michael E. Campbell
No solutions at all.
Received one of the first copies early in 2006. Wanted very much to apply their ideas.
After re-reading the highlighted pages my summary produced a BLANK page. Read more
After re-reading the highlighted pages my summary produced a BLANK page. Read more
Published 23 months ago by Dr. Don Malnati
Good try
As an avid follower of this space I was excited to see Michael Porter write on the topic. The topic is too wide and I was wondering how much time did Michael Porter spend on... Read more
Published 23 months ago by V. Chandna
Valuable addition to the Health Care debate
As the son of a physician, I have a fondness for all things medical... except the current state of our American health care system! Read more
Published on March 30, 2009 by Thomas H. Pyle
Front Cover | Front Flap | Table of Contents | First Pages | Index | Back Flap | Back Cover | Surprise Me!
Inside This Book
(learn more)
First Sentence:
THE U.S. HEALTH CARE SYSTEM is on a dangerous path, with a toxic combination of high costs, uneven quality, frequent errors, and limited access to care. Read the first page Key Phrases - Statistically Improbable Phrases (SIPs): (learn more)
full care cycle, integrated practice units, addressing particular medical conditions, mandatory health coverage, care delivery chain, medical condition level, addressing medical conditions, provider excellence, delivery value chain, other system participants, care delivery methods, medical integration, substandard providers, care delivery structures, health care value, care cycles, health care competition, excellent providers, disease management services, tailored facilities, skewed incentives, care delivery process, discrete interventions, patient value, many health plans Key Phrases - Capitalized Phrases (CAPs): (learn more)
United States, Principles of Value-Based Competition, Identifying the Root Causes, Cleveland Clinic, Anderson Cancer Center, New York, The Clinic, Best Doctors, Intermountain Health Care, The Institute of Medicine, New England Baptist Hospital, Boston Spine Group, Harvard Pilgrim, National Quality Forum, Scoping the Problem, Preferred Global Health, Dartmouth-Hitchcock Medical Center, Certificate of Need, New Hampshire, Rochester General Hospital, United Resource Networks, American Hospital Association, Texas Back Institute, Blue Cross Blue Shield, Consumer's Medical Resource New!
Books on Related Topics | Concordance | Text Stats Browse Sample Pages:
Front Cover | Front Flap | Table of Contents | First Pages | Index | Back Flap | Back Cover | Surprise Me!
THE U.S. HEALTH CARE SYSTEM is on a dangerous path, with a toxic combination of high costs, uneven quality, frequent errors, and limited access to care. Read the first page Key Phrases - Statistically Improbable Phrases (SIPs): (learn more)
full care cycle, integrated practice units, addressing particular medical conditions, mandatory health coverage, care delivery chain, medical condition level, addressing medical conditions, provider excellence, delivery value chain, other system participants, care delivery methods, medical integration, substandard providers, care delivery structures, health care value, care cycles, health care competition, excellent providers, disease management services, tailored facilities, skewed incentives, care delivery process, discrete interventions, patient value, many health plans Key Phrases - Capitalized Phrases (CAPs): (learn more)
United States, Principles of Value-Based Competition, Identifying the Root Causes, Cleveland Clinic, Anderson Cancer Center, New York, The Clinic, Best Doctors, Intermountain Health Care, The Institute of Medicine, New England Baptist Hospital, Boston Spine Group, Harvard Pilgrim, National Quality Forum, Scoping the Problem, Preferred Global Health, Dartmouth-Hitchcock Medical Center, Certificate of Need, New Hampshire, Rochester General Hospital, United Resource Networks, American Hospital Association, Texas Back Institute, Blue Cross Blue Shield, Consumer's Medical Resource New!
Books on Related Topics | Concordance | Text Stats Browse Sample Pages:
Front Cover | Front Flap | Table of Contents | First Pages | Index | Back Flap | Back Cover | Surprise Me!
Citations (learn more)
This book cites 47
books:
See all 47 books this book cites
- Medical Care Output and Productivity (National Bureau of Economic Research Studies in Income and Wealth) by David M. Cutler on 4 pages
- Cystic Fibrosis (Your Personal Health Series) on page 128, Back Matter (1), and Back Matter (2)
- New Technology by Sounter Information Services in Back Matter (1), and Back Matter (2)
- Health Care (Careers for Today) by Linda Barrett in Back Matter (1), and Back Matter (2)
- Measuring the Gains from Medical Research: An Economic Approach by Kevin M. Murphy in Back Matter (1), and Back Matter (2)
See all 47 books this book cites
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