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Redefining Health Care: Creating Value-Based Competition on Results Hardcover – May 25, 2006


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Product Details

  • Hardcover: 528 pages
  • Publisher: Harvard Business Review Press; 1 edition (May 25, 2006)
  • Language: English
  • ISBN-10: 1591397782
  • ISBN-13: 978-1591397786
  • Product Dimensions: 9.4 x 6.5 x 1.7 inches
  • Shipping Weight: 2 pounds (View shipping rates and policies)
  • Average Customer Review: 3.8 out of 5 stars  See all reviews (51 customer reviews)
  • Amazon Best Sellers Rank: #62,007 in Books (See Top 100 in Books)

Editorial Reviews

Review

"...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.

More About the Author

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

I read every page, but learned nothing.
Dr. Don
This book provides a clear vision of how the U.S. can reduce health care costs while improving patient outcomes - without increased complexity.
Loyd E. Eskildson
Some comclusions can be challenged, but the book bringing a new look on Health Care and provide solutions for improvements.
Igor

Most Helpful Customer Reviews

99 of 113 people found the following review helpful A Kid's Review on July 31, 2010
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.
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19 of 22 people found the following review helpful By Loyd E. Eskildson HALL OF FAME on August 2, 2006
Format: Hardcover 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.
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14 of 18 people found the following review helpful By Charles Weller on June 1, 2006
Format: Hardcover
This book by Porter and Teisberg contains the only new and untried model for health care in 70+ years. Conceptually, it is remarkably simple: regroup health care thinking and payment to providers by disease, what the authors call "medical condition." Like PPOs in the 1980s, this essentially private solution can be put in place quickly. It requires no government action or legislation, as a legal matter is not insurance in key respects and thus is not limited to insurers and HMOs but can be implemented by a large variety of innovators, without state insurance regulation. Among its breakthroughs are its focus on health care results for patients, and its rejection of two conventional assumptions: that doctors and hospitals should be paid separately regardless of patient outcome and that health care is local.

Their book makes America's health care system today like the horse and buggy industry in 1890 -- and it's a detailed guide to the automobile.
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27 of 37 people found the following review helpful By D. Racer on November 5, 2006
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.
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Format: Hardcover
Those who have read Porter's previously published On Competition no doubt recall the excellent material on which he and Teisberg collaborated in Chapter 12, "Making Competition in Health Care Work," originally published in Harvard Business Review (July/August 1994). They collaborate again on this volume in which they examine health care issues in three broad areas: "The first is the cost of and access to health insurance. The second is standards for coverage, or the types of care that should be covered by insurance versus being the responsibility of the individual. The third is the structure of health care delivery itself." Porter and Teisberg explain why the only way to truly reform health care is to reform the nature of competition itself. More specifically, to transform health care by realigning competition with value for patients."How to do so is the central focus of this book."

How to explain dysfunctional competition in health care? Porter and Teisberg suggest several which include "misaligned incentives and a series if understandable but unfortunate strategic, organizational, and regulatory choices by each participant in the system that feed on and exacerbate each other. All actors in the system share responsibility for the problem....The problem is that competition does not take place at the medical condition level, nor over the full care cycle. Competition is the current system is at the same time too broad, too narrow, and too local."

This year in the United States alone, at least $2 trillion will be spent on health care, and costs will continue to escalate. While conducting their research, Porter and Teisberg concluded that there should be no presumption that good quality of health care is more costly.
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