Why RHIOs Aren't Working: Views from an American Who Can See White Rock, British Columbia, from His Backyard

David E. Garets FHIMSS, President & CEO, HIMSS Analytics

Misaligned Incentives

[This article responds to: US Regional Health Information Organizations and the Nationwide Health Information Network: Any Lessons . . . ?]

Our "system" is "distinguished" by an incredible lack of aligned incentives.

• Insurance companies want to keep their insured consumers from engaging in expensive procedures or showing up in expensive venues (emergency departments) and have a reputation for looking for creative ways to not pay for medical services.


• Hospitals think they're the centre of the medical universe and make their money getting most of the sick people and providing as many services for them as are reimbursable by the tight-fisted insurers.


• Most American physicians are independent business people trying to maximize their incomes and attempting to gain leverage from hospital competition in their communities.


• Pharmaceutical companies, for the most part publicly held manufacturing firms, are intent on maximizing their profits and have figured out how to be successful - spend billions of dollars lobbying the US Congress to keep price controls and imported drugs out of the country while marketing directly to consumers.


• US residents, 47 million of whom are uninsured (approximately 16% of the population), are left to fend for themselves with competing doctors, hospitals, pharmaceutical companies eager to have them "ask your doctor whether whatever drug we're pushing today is right for you." In the United States, the costs for this madness are escalating far faster than inflation and presently comprise at least 15% of the US gross domestic product, a far higher percentage than in any other developed country, with poorer outcomes.


• And finally, employers, who fund a large percentage of the healthcare costs for employed Americans and their families, are furious at the increasingly large bite employee and retiree healthcare costs are taking out of their profits, making it increasingly difficult for many of them to be globally competitive. They're trying to get a handle on containing those costs. In large part, they attempt to manage this by shifting more of the costs to their employees.

I don't mean to be cynical, but RHIOs are the least of our worries!

Let Me Count the Hurdles [ . . . to continue click here.]