Of Castles and Trebuchets

Throughout history, investing in capital-intensive, fixed-defensive positions has failed as a military strategy.  For more information, see castle v trebuchet, Great Wall v The Hun, Siegfried Line v Patton’s highly mobile Third Army.  Indeed, rapidly deployed, highly flexible Special Forces are working well in today’s warfare, not heavy bombers, rear artillery, or cruise missiles.

castle ruins in scotland near urquhart, better pic

In today’s healthcare, I continue to see capital-intensive, fixed-defensive positions being built, despite our county’s inability to afford such infrastructure, and despite the clinical requirement we relocate our healthcare from single, stationary to multiple, mobile locations.  Oh yeah … the pace of change in the industry is very much akin to the speed of today’s warfare.  For more information, see hospital oligopolies and single-specialty mega-groups, the creation of which is solely designed to fix high prices in a marketplace changing how heatlhcare is paid.

hospital facade, good sam

What if a more mobile healthcare delivery system, made possible by low-cost IT-peripherals and connectivity, was the better strategic choice, both offensively and defensively?  Imagine a patient being electronically “touched” by her physician team 4 times a month for preventive health, wellness, nutrition and disease management, rather than a single office visit + ER visit + collateral costs from inadequately managed DM?  The combined cost of the mobile care and connectivity, driven by true population-based care, would have to be 50% less than the cost of building and maintaining today’s healthcare castles (stone and mortar, guards, wardrobes of kings and queens, maintenance on the moat, etc).

medical informatics doctor

Regardless, we’ve got to get America’s healthcare spend from the current 18% GDP to 12-14% over the next ten years.  That can’t happen if we continue to invest in the capital-intesive anachronisms of fee-for-service (FFS) healthcare.


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  1. Pingback: In Search of the Holy Grail - the what | Leadership in Health CareLeadership in Health Care

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