

Several disruptive innovations will soon make life harder for health care’s established giants - matstc
http://www.economist.com/theworldin/displayStory.cfm?story_id=12494662&d=2009

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Xichekolas
I think retail medic clinics like those increasingly found in Wal-mart will be
a hugely beneficial development.

There is no reason to pay a doctor $175 to tell one of his assistants to swab
your throat for strep and stick it in a machine to analyze when you can pay a
technician at Wal-mart $25 to do the same thing.

These services make sense for the same reason you don't take your car to an
Automotive Engineer to change the oil or fix a flat tire.

~~~
lbrandy
Except sometimes when you go to the doctor for that sore throat he notices you
have throat cancer.

The Wal-Mart tech tells you it's negative for strep and sends you home with
some Tylenol Flu medicine.

~~~
Xichekolas
Well when the Tylenol doesn't help after a day or so you can go to a real
doctor as the next step.

If the sore throat _does_ go away (not related to the cancer), then hopefully
your real doctor will catch said cancer during your yearly physical.

I'm not saying these places should replace real doctors for everything, I'm
saying for the 98% of the time it's a common ailment like strep or the flu,
they can save everyone a lot of time and money.

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TheWama
Another interesting development is primary care for cash, or "direct primary
care". Somewhere between retail health clinics at the low end and concierge
medicine at the high end, these are doctors you subscribe with for something
on the order of $50 a month for a personal relationship with a primary care
doctor.

Because of the compensation model, they've embraced conveniences like e-mail,
phone calls and text messaging for communication, as well as once-common house
calls.

They're also able to better-compensate their doctors and provide longer, more
immediate appointments because they don't have nearly the overhead of an
insurance-financed medical practice. This could help stem the tide of doctors
leaving primary care practice
([http://www.entrepreneurialmd.com/index/2008/11/18/angry-
prim...](http://www.entrepreneurialmd.com/index/2008/11/18/angry-primary-care-
physicians-are-just-saying-no.html)), a trend which does not bode well for the
future state of preventative medical care.

It's a very early trend, but I'm looking forward to seeing it develop. I
currently know of Qliance (<http://qliance.com/>) in Seattle and Hello Health
(<http://hellohealth.com/>) in Brooklyn. For more, you can check out videos
from each organizations' founder: Dr. Garrison Bliss
([http://www.tvw.org/media/mediaplayer.cfm?evid=2008030136C...](http://www.tvw.org/media/mediaplayer.cfm?evid=2008030136C&TYPE=V&CFID=797374&CFTOKEN=98512569&bhcp=1))
and Dr. Jay Parkinson (<http://vimeo.com/2082073>)

~~~
pchivers
I would love to have primary care for cash here in Canada. Given the current
system, you can't receive a given medical treatment unless you can convince a
doctor to authorize it. Even if you are willing to pay out of pocket, you are
out of luck unless you can find a doctor who is on the same page as you.

Right now, I'm trying to get a blood test for Vitamin D, but all the doctors
I've gone to see are ignorant of the latest Vitamin D research, and don't see
the value of doing the test. If I can't find a doctor who will authorize it in
the next year or so, then I'm probably going to drive down to the US and pay
cash using Direct Labs (<http://www.directlabs.com/>) or the Life Extension
Foundation (<http://www.lef.org/>). It's terribly inefficient but I don't see
any way around it.

~~~
pasbesoin
I'm curious as to what research you're referencing. I started taking a vitamin
D supplement a few weeks ago at the encouragement of my father, and it seems
to be making a difference in my sense of well-being, but I'd welcome a few
pointers if you have any handy. (Don't mean to impose, though.)

~~~
pchivers
The big study on vitamin D that got everyone's attention was this one from the
summer of 2007:

 _Vitamin D and Calcium Supplementation Reduces Cancer Risk: Results of a
Randomized Trial_ (<http://www.ajcn.org/cgi/content/abstract/85/6/1586>)

There is also a lot of information about vitamin D research at the Vitamin D
Council website (<http://www.vitamindcouncil.org/>).

That being said, I don't know if taking a vitamin D supplement would have any
noticeable effect on your sense of well-being. I think it's probably a good
idea to take one even if you don't notice a difference.

~~~
pasbesoin
> I don't know if taking a vitamin D supplement would have any noticeable
> effect on your sense of well-being

Yeah, that was totally unexpected and is purely anecdotal.

------
lunchbox
A generally good article, but the last section, which discussed online medical
records, was a bit vague. First, the author doesn't distinguish between
enterprise health information systems (which doctors/hospitals use internally
to create and maintain health records), and personal health records (such as
Microsoft HealthVault and Google Health, which let patients aggregate their
health information from different institutions). Although these two spaces are
highly complementary (since health data will be interchanged between the two),
they are different applications with different business models. Think of it as
the difference between the software that Bank of America uses internally to
manage its customer accounts, and a personal finance app like Quicken Online.

So when the author talks about VCs investing heavily in stealth challengers to
Microsoft and Google, I'm not sure what he's referring to. The main reason
Microsoft and Google are moving slowly is that the adoption of personal health
records requires a lot of infrastructural changes: affiliations with
hospitals/insurers/medical device makers/employers, adoption of standards for
the exchange of medical information, and overcoming concerns over privacy and
security. As a result, even if these startups emerge in 2009 with technology
or business models that beat Google/Microsoft, I think it would realistically
take at least a couple of years for them to gain traction. I would love to be
proven wrong, though.

