Disruptive Technology #4: Ebay, auctions, and markets

I’ve noticed that “markets” have not been discussed as contributing to or (at the very least) affecting health care and eHealth. Perhaps this is because I am in a Canadian context where anything that remotely challenges the tenets of the Health Care Act are pooh-poohed and dismissed as being somehow “un-Canadian” or ideological. For today’s profile, I will focus on the disruptive technology that I call “markets, auctions, and eBay”.

Whether people like it or not, economic markets have a role to play. We accept them in almost every aspect of life except for health care. I’m not suggesting that we replace the centralized, publicly operated existing systems with privatized systems. But, I think that we need to begin to realize that markets and online auctions will play a role in the future of eHealth and health care. Initially, I suspect that physical goods will be bought and sold, but it will not take long for services to traded.

In Canada, we have a collection of provincial health systems that essentially pay for (but do not operate) health services. Recently, home care services were opened up to a competitive bidding process, under the guise of providing quality at a reasonable price. If we are out-sourcing and auctioning off services in home care, why can’t other aspects of care be auctioned through eBay?
In some sense, this type of behaviour already exists – we just don’t really seem to mind it. All you need to do is look at the selling of naming rights for new wings, clinical research chairs, and whatever else people are willing to get named.

From a patient’s perspective, why would they want to go on the Internet and bid for services? Well, quite simply, it comes down to a matter of choice and vulnerability. When faced with a desperate situation (i.e., a terminal disease or waiting for some certainty), people will generally do whatever they can to resolve the situation. In Canada, our system is grappling with the idea of rationalized care, which has resulted in (arguably) long wait times for services. If financially able, why wouldn’t a patient go on the Internet and acquire a diagnostic test, second opinion, or even treatment over the Internet or through some competitive bidding process. In this interconnected, global economy why can’t health professionals in other countries compete with local providers for services? Remember that in this emerging ehealth world, distance and place are not supposed to be barriers.

Again, I’m not suggesting we replace our systems with market-driven systems. I’m just hoping to open up the discussion and discourse on something that will have an impact on existing systems, whether we want it to happen or not. My sneaking suspicion will be that markets and for lack of a better term “eBay” services will first hit the area of scheduling in two ways.

First, I can imagine how health professionals may wish to differentiate themselves with other professionals by offering different time schedules, essentially creating a “market” for patients. Who wants to wait months for Doctor A if I can go next week to see Doctor B after hours?

Second, I suspect that patients may start bidding for more convenient and/or earlier time slots for access to diagnostic testing services (like the MRI), to see famous specialists, or even treatment options. This type of behaviour would probably happen unofficially where patients would contact patients with earlier and more “desirable” time slots and pay to either switch or give up their appointment.

Another likely scenario would be for governments to auction off patient care to private care providers, regional groups, or even hospitals. The government (or insurance company) would set a maximum rate and volume of services needed (e.g., dialysis or outpatient surgeries) and open it up to competition for the contract. I recall how in Alberta the government went to private care providers to treat patients so that wait times could be decreased (it was cataract surgery and hip replacements I think). The government paid the same rate as it was paying public hospitals.

Markets and eBay are likely to affect health care in the future. Who knows, we may end-up shopping for a doctor’s appointment online and bidding for services.

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