“disrupting Health insurance” ≠ “improving the quality of healthcare

A few days ago I saw the following on my twitter feed:

I followed the link to the HIMSS website. What are the 4 ways in the Tweet? Well, they are:

  • The Use of Wearables in Wellness Plans
  • Three billion mHealth App Downloads and counting
  • Sensors and apps are everywhere
  • The Big Data Revolution

According to the blog post at least. I’ll leave it to the reader to make their own judgment.

I guess it may have been the trigger word “disrupting”, but I posted a rather grumpy tweet:

To which, shortly after, came a reply:


Perhaps I should have replied “solutions to what exactly?” (cf prior posting on solutionism) Anyhow, I replied and Stefan graciously replied and a rather civil exchange ensued.

Thinking about it again, perhaps I deviated from my original point too fast. Health insurers are in the business of selling a product to consumers. The product is coverage for access to healthcare – they are not providers of health care itself. Surveying the world of digital health, I sometimes wonder if the complexities and vagaries of the US healthcare sector – which represents the highest proportion of GNP of any developed country, and yet is notoriously complex, difficult to navigate, and all round obtuse – deforms how many players approach the sector. We often hear about engaging clinicians and “clinical workflows.” Insurers are clearly players in the game, and important players (especially in the US) but they are not clinicians or indeed service users.

I keep coming back to Neil Versel’s piece (and the comments following) from Feb 2013:

What those projects all have in common is that they never figured out some of the basic realities of healthcare. Fitness and healthcare are distinct markets. The vast majority of healthcare spending comes not from workout freaks and the worried well, but from chronic diseases and acute care. Sure, you can prevent a lot of future ailments by promoting active lifestyles today, but you might not see a return on investment for decades.

And indeed, other factors may scupper your promotion of active lifestyles – all of this can be for naught with highly effective technologies encouraging consumption of calories and media (“binge culture” has several sides) at the same time.

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