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

3.9 out of 5 stars 61 customer reviews

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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 E. Porter is the C. Roland Christensen Professor of Business Administration at the Harvard Business School. The author of fourteen books and recipient of the Wells Prize in Economics, he lives in Brookline, Massachusetts.
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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: 1.5 x 6.5 x 9.5 inches
  • Shipping Weight: 2 pounds (View shipping rates and policies)
  • Average Customer Review: 3.9 out of 5 stars  See all reviews (61 customer reviews)
  • Amazon Best Sellers Rank: #42,840 in Books (See Top 100 in Books)

Customer Reviews

Top Customer Reviews

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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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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Format: Hardcover Verified Purchase
This book has received probably disproportionate attention due to Prof. Porter's notoriety as a strategic thinking theorist. There are better overall books on healthcare policy available. In particular I recommend the Bodenheimer/Grumbach books, one on healthcare policy and one on primary care, Dr. Arnold Relman's book, A Second Opinion, Strained Mercy, an outstanding and thorough analysis of healthcare economics with particular regard to Canada's healthcare system and Pricing the Priceless a more technically-oriented economic analysis by Prof. Joseph Newhouse, among other books.

I find the analysis of the USA healthcare system by Profs. Porter and Teisberg to generally be excellent, although I find it wanting in regard to their disparagement of a single-payer/single-insurer system and to their description and analysis of healthcare systems outside the USA. From my perspective private health plans play only a net negative role in the system. The authors' analysis of how the health insurance market works is quite good. However their recommendation that a system of private insurers should persist is refuted by their own analysis! A single payer/insurer system will not cure many problems of the USA system, as they clearly point out, but it does remove the inherently dysfunctional characteristics of private insurance, not least of which is its failure to meet the needs of the uninsured - a very large number - and its inherent propensity to exclude the very people who need coverage and care.
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Format: Hardcover
“Redefining Health Care” focuses on medical and other related services can emphasize delivery of value, not just on containment of costs as the key to reforming this vital sector of our economy. The book looks at how the health field can utilize competition centered on the treatment of medical conditions over the full cycle of care as that means of delivering value.

In chapters 1, 2, 3 and 4, the authors lay out the heart of their message. In chapters 5, 6, 7 and 8, the authors explain the strategic and organizational implications of these ideas. More specifically each one of the latter, treats the ramifications for health care providers, health plans, as well as for suppliers (e.g. Biotech/Pharmaceutical companies and Medical Device makers), consumers, employers, and policy makers respectively.

For this reviewer, the added value of this book is In excess of 50 visual figures, charts and boxes that the authors use to “define” health care and then propose how they would redefine it. Not only in the body of the book, but also in appendices, they have provided helpful illustrations of the care delivery value chain.

As the authors indicated in 2006 when the book was published, the redefinition of which they speak was already beginning to occur. It seems that such activities have increased with the Affordable Care Act, but it would be helpful to have an updated edition that would speak to whether and where such increases have occurred (see Steven Brill's "America's Brittle Pill" which addresses many of the pro's and con's surrounding the Acts passage/implementation and seems to reaffirm the need for attention suggested in this book)

In any case, “Redefining Health Care” continues to be a useful reference in understanding this important industry and sector of human activity.
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