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Monday, November 9, 2015

The Medical Industrial Complex

I belong to a lot of different mailing lists.  The obvious ones are HL7 and IHE workgroups, but other lists relate to S&I Framework activities, AMIA informatics workgroups, and the Society for Participatory Medicine.  One of the things I find most interesting, and also the most frustrating about these lists is the sometimes ethnocentric bias commonly found.  Nobody is exempt from this (even me).

A recent term showed up on one of these lists: Medical Industrial Complex

Usually this term is used disparagingly. I find that each different list thinks about this term somewhat differently.

  • Some think about it as "the vendors", referring to sellers of medical devices, software, et cetera (e.g., like my employer).  This often shows up from the perspective of providers, and sometimes the government.
  • Others think about it as "the payers", referring to the health insurance industry.  Many times, this shows up from either perspective of providers, or patients. 
  • Others think about it as "the healthcare providers", referring to doctors, hospitals, et cetera. This is most often the perspective of patients, although sometimes the perspective of individual providers dealing with institutional providers (hospitals or groups).
  • Others think that a significant chunk of the Medical Industrial Complex is sponsored and controlled by "the government", a perspective espoused often by any group other than "the government".
The Medical Industrial Complex, or its constituents as an aggregate group (all of the above) are easy targets.  They are motivated by money (profit or savings depending on the role), not saving lives. They have no interest in the concerns of any other stakeholder, including the patient.  

The medical industrial complex is in fact too easy a target.  We oversimplify the situation in ways that rarely result in any problem being solved.  Claiming, for example, that "____ are against interoperability because it is not in their best interest." is simply divisive, and not useful.  Oh, and I've seen that sentence filled out at least three different ways.

Presently, the Medical Industrial Complex is a multi-player, zero-sum game.  That means where one group gains, another loses.  All of us reading this blog are players in this game in some way.  If the game isn't fun, what we need to do is change the rules, but that's going to require all of us in this thing that people call the "Medical Industrial Complex" to work together.  Yes, that means you.  What are you going to do about it?