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Design and Health: Flipping The Pyramid


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It’s easy for two people to look at the same information – such as this chart (above) about health costs – and perceive totally different things. What I see is an out-of-control Medical Industrial Complex that’s heading, Icarus-like, for collapse. What many designers see is a sea of opportunity – and boy do they want a piece of that action.

They are not alone. Many city-regions regions see the ‘health space’ as an opportunity for growth. In the Netherlands, for example, Groningen’s Healthy Ageing Campus is billed as a “research and entrepreneurship zone” that will focus on healthcare, food & health, medical technology, and pharma.

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In Eindhoven, too, a project called Brainport Health Innovation (BHI) will focus on “well-being for the elderly and chronically ill…while generating economic opportunities for the region”.

The pattern is Europe-wide: an organization called Healthclusternet is encouraging all the EU’s 27 member nations to develop “regional health systems and health innovation markets”.

The promise of economic opportunity persuaded its sponsors to pay for last week’s World Design Forum in Eindhoven on the theme of “Creating a Caring Society”.

Eindhoven, home of Philips and the lightbulb, was recently voted “smartest region in the world” for its prowess as an innovator of high-value, technology-based products. A meeting to explore how this smartness might be applied to the global care market must have seemed a promising idea.

The only problem? Our discussion raised the possibility that a complex, doctor-intensive, technology-based approach may not be an affordable, or even necessary, ingredient of caring society.

My contrarian advice was that we need to grow care systems based on five per cent of the costs per person that we have now. This sounds like a fantasy, but is not. In Cuba, for example, where food, petrol and oil all have been scarce for of 50 years as a consequence of economic blockades, its citizens “achieve the same level of health for only 5% of the health care expenditure of Americans.”

The use of Cuba as a benchmark is a hard sell at health industry events. Imagine my surprise in Eindhoven, then, when a Cuban-style strategy was advocated by someone with real financial clout. Roger van Boxtel, CEO of a big Dutch insurance company, Menzis, used this [admittedly hideous] upside-down pyramid to describe how his company plans to re-direct spending for its two million insured clients.

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The tiny triangle on top of the right-hand pyramid – marked “soon” – represents pretty much the entirety of resources for today’s Medical Industrial Complex. When I asked the head of a huge hospital, on the same panel, what he made of this startling transformation in resource allocation, his rueful reply was that “if he says so, that’s the way things will go”.

Menzis does not propose to do away with hospitals altogether. But it does intend to reduce costs radically by focusing common procedures at a small number of preferred suppliers. It will send all patients for hip replacement, for example, to one clinic, Maartsenkliniek, which already performs 700 hip operations a year.

Logically, it is hard to see why Menzis’ inversion of the Follow-The-Money principle should stop at Dutch borders. An international patient visiting India can save 70 to 80 per cent on the average cost of similar procedure back home. Hip replacement surgery at the top rated hospital in India costs US$5,000 – including the cost of an FDA approved implant or prosthesis.

] Departure Lounge

Medical tourism to India is not the kind of patient journey that intrigues designers – or at least, not yet.

In Eindhoven, our jaws dropped at a gorgeous presentation, by Paul Priestman, of his Recovery Room of the future. Priestman drew on his expertise as designer of Lufthansa’s first class cabin to argue that hospitals do not have to be clinical, inefficient and unwelcoming.

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Lufthansa-quality recovery lounges in hospitals would of course be lovely – but they are unlikely to reduce the cost explosion in health. The cost to an airline for a ‘super first class’ model, with its 600 parts, can reach $160k [114k euros] per seat. When you consider that only five per cent of the world’s population has flown on an airplane at all, let alone in first class, high-end Recovery Lounges look likely to remain a niche market.

To be fair, Priestman was adamant that other forms of care collaboration is so important.

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