The history of healthcare delivery in the US parallels the history of technology. Until the internet age, the most important technological advance in the history of healthcare delivery was not the CAT scanner or the MRI machine. It was the invention of the automobile and the proliferation of paved roads. This is the story of how the road changed healthcare delivery, and how the internet is changing it once again.
Bad Good Old Days
From colonial times until the early 20th century, if you fell ill, you sent a family member to fetch the doctor, often on horseback. Once the physician arrived, he would ask questions, lay on hands, come up with a diagnosis, and prescribe a “physic”. The simple presence of the doctor in the home was probably more effective than any available folk remedy. The therapeutic effect of care in the home is something that has not changed with time. Unfortunately, this form of care delivery had all but disappeared by the mid-20th century.
The Two-lane Blacktop Changes Everything
Though Henry Ford started mass producing automobiles in 1908, it was not until the widespread paving of roads that the nature of healthcare delivery began to change dramatically. Once roads were paved, physicians discovered that it was more efficient to have patients come to see them in an office, rather than visit the patient in their home. This way, the physician could see many more patients in a day.
Simultaneously, the world of medicine saw an enormous expansion of diagnostic tools like the x-ray machine, and a revolution in therapeutics led by the discovery of antibiotics. There is no question that technology prolonged the average lifespan and improved the quality of our lives. But all the benefits provided by the personal touch of a caregiver in the home was lost, seemingly forever…
…And Then That Internet Thing Happened
The internet is already changing the way patients receive healthcare. The explosion of apps, wearable devices and handheld devices is permitting patients to connect with caregivers in a close personal way that has not been possible since colonial days. What is more, the market, i.e. the patients themselves, is demanding more personalization of medicine and more delivery of services at home. The paved road moved healthcare delivery from the home to the doctor’s office. The internet is moving healthcare delivery back to the home.
As patients become more accustomed to communicating with caregivers at home, they will increasingly demand home visits as well. A major difference between modern and colonial times is that in the intervening centuries we have enjoyed an expansion of professionalization of caregivers, from home health aides to skilled visiting nurses. Even the physicians themselves are doing more home visits than in previous generations.
Staying Ahead of the Curve
Professional healthcare organizations and payers must recognize that the center of gravity in medicine is moving away from the hospital and physician’s office and toward the patient’s home. It is incumbent upon medical professionals and payers to stay ahead of the curve. If they do not provide patients with platforms and applications to coordinate their own care in conjunction with physicians, the market will provide other, less optimal means.
The objective should always be the best outcome for the patient. Medical professionals and payers have the responsibility of ensuring that patient preferences and choices are guided by best practices and evidence based guidelines. This is the surest way to restore to patients the feeling of comfort and reassurance that, once upon a time, was afforded them by a visit from the physician.