‘This app is basically the next Uber for healthcare’

A web search for the phrase uber for healthcare yields around 11,100,000 hits along with a plethora of suggested related searches. Uber has become shorthand for customer convenience and the disruption of established markets. It seems many people are looking for the lucrative uber for healthcare model and it’s a phrase with currency at many digital health events and in numerous articles.

This recent Kevin.MD blog post argues that an uber for healthcare will be ‘super convenient, quick and easy, and inexpensive’. A recent commissioned article in the weighty British Medical Journal, entitled Uber for Healthcare asks:

 

Is it time to reinvent the home visit? … app happy entrepreneurs backed by venture capitalists believe that they can turn back the clock (Hawkes, N. 12 February, 2016).

 

The idea of a quick and convenient healthcare system that we can access with a swipe of our app while we go about our busy lives is seductive. But should we be questioning more deeply whether we want app happy entrepreneurs backed by venture capitalists disrupting the NHS with uber-style models of healthcare?

Relationships or transactions

An uberised model of healthcare prioritises transactions over relationships – it elevates convenience, efficiency and accessibility. But arguably healthcare is much more complex than an A to B taxi journey for all but the most simple of ailments. What happens to an uberised model when referrals along a multi-provider care pathway are required or ongoing support to help someone manage multiple long term health conditions? An uber style healthcare model may benefit the generally fit and affluent who can afford private healthcare, but not people who are poor, excluded or who have more significant needs.

Healthcare is defined by complexity. But it’s also defined by relationships. Advocates of uberised models seem to forget that healthcare is about relationships and trust just as much as it is about diagnosis and prescriptions. As Tom Valenti writing in Techcrunch puts it:

 

Healthcare is not a transaction business; it is a relationship business. One cannot “get healthy” with a one-time, immediate transaction. Instead, positive health outcomes are achieved over a long time period through a treatment plan developed in conjunction with a trained physician with whom a patient has a strong relationship.

 

In the uber for healthcare paradigm the language of the market place trumps the language of empathy, care and compassion – the sorts of values enshrined in our NHS Constitution. Is an uber for healthcare a helpful way of thinking about the future of digital innovation in health? I’m not so sure.

Old and new business models

Even if a transactional approach to healthcare is possible and we can conveniently access our health practitioner whenever and wherever we need them, what is the underlying uber style business model and is it desirable in the context of our national health service?

In his recent book Throwing Rocks at the Google Bus Douglas Rushkoff deconstructs the Uber business model and exposes aggressive business practices than belie the user-friendly ‘tap and ride’ app with its ‘you rate, we listen’ functionality. He argues that, whilst the venture capitalist backed Uber is valued at over $18 billion, many of its drivers make below minimum wage after expenses. Uber ruthlessly puts independent taxi companies out of business and uses tactics such as price surging at peak times to increase profits.  According to Rushkoff, Uber’s business model is about extracting value for venture capitalist investors at all costs – a sharing economy facade with a growth-based winner-takes-all business model behind it. When other taxi firms have been put out business, what does this mean for customers when all we have left is an Uber monopoly?

I wonder what an uber-style monopoly would look like in health and what it would mean for us as patients and for healthcare practitioners.

Happy staff = happy patients

If you put the words uber driver and toilet into a search engine* you will find many articles and forum threads discussing how to take a toilet break, along with some ingenious methods for managing this tricky issue, when you don’t have a physical base. An uber style healthcare model not only smacks of aggressive business practices but also of a disregard for meeting the basic needs of workers.

We know there is a strong and clear correlation between staff satisfaction and patient health outcomes so do what does an uberised workforce mean not only for staff but for patients? This leads me to question whether an uber for healthcare paradigm helps us think in the right way about what our healthcare practitioners need to do their job well or if it runs the risk of being highly alienating.

A different conversation

So next time you hear someone talk about an uber for healthcare it might be worth challenging them to think not only the assumption that healthcare is about simple transactions, but also to consider the business models and employment practices that might underpin it.

I don’t think there will be an uber for healthcare anytime soon in the NHS but I do hope we can stop using it as shorthand for digital innovation in healthcare.  Let’s have a different conversation about the role of digital technologies in health that is focused on reimagining an NHS system of the future based on our NHS values and focused on trust and relationships as much as convenience and efficiency.

And if you are interested in the finding out more about Rushkoff’s work then I highly recommend this talk about how growth has become the enemy of prosperity:

* thank you to @markoneinfour for pointing this out to me.