USUALLY when we think of the private sector, we imagine large corporations indifferent to the consumer and patients, focused on increasing the wealth of shareholders. However, if we think of “not government,” which is different from non-governmental, the family (including single persons) and voluntary organizations comprise a large and unrecognized share of the private sector.
I contend that two technological trends will shift the locus of health care from the public sector to individuals or the private sector. But first I offer a personal vignette.
Some 15 years ago while on our annual winter pilgrimage to Mexico, one of my family fell ill. The hotel staff advised us to go to an emergency room and we saw a physician at 9 a.m., who requested the usual blood and urine tests from a lab down the hall. The technician advised us to monitor our email and, sure enough, at 4 p.m., we received a complete analysis of the results, with the offending microbe identified and a recommended medication. Showing the email to a pharmacist resulted in having the treatment by 5 p.m., just eight hours after seeing the physician.
Sure, we might have experienced “gringo” medicine, not available to the typical Mexican. Yet in speaking with middle-class Mexican friends, they assured us that our experience was quite typical of what Mexicans have come to expect through their privately purchased insurance.
I offer this story not to advocate for private provision of services — that is a much more complex topic than I can address here. Rather, my point is that the system conserved our time and treated us like adults. We received comprehensive information, with a recommended course of action. We were in control.
In Canada, the process of diagnosis and treatment for a stomach bug could stretch over several days as we trundle between physician, lab, back to physician, and then to pharmacy.
Back to the point of this article.
The first technical revolution that will prompt change involves wearable diagnostic technology. We see this in the patches worn to monitor blood sugar for diabetics. Heart health monitoring through smartphones has become a reality and while some functions remain hard to monitor, such as obtaining consistent blood pressure readings, given current progress, within the next five years we will see these wearable technologies linked to smartphones become real-time personal medical surveillance devices.
Now, were I able to combine this functionality with all my medical data, my phone becomes the locus for the totality of my health information.
Others have argued in these pages that personal medical information is the property of the individual. Yet the system currently hoards this information. Before anyone objects to this possibility on privacy and security grounds, remember for many of us, our phones are the gateway to banking and taxation data, surely as critical to keep secret as health data.
The second technical revolution is where things get exciting. AI is all the rage, and the weekly advances are rapid, even allowing for the breathless hype that usually accompanies innovative technologies. Just six months ago, experiments with GPT-4, the most common large language model offered unreliable and inconsistent diagnoses. Physicians could be dismissive. No more.
One important benefit of AI is a reduction in misdiagnoses. A recent study by Johns Hopkins suggests that in the United States misdiagnoses account for about a million deaths and permanent cases of morbidity annually. A randomized trial that compared the diagnostic accuracy of AI versus medical specialists gave the edge in accuracy to AI, suggesting that increased use of AI could reduce the costs of misdiagnosis. Isaac Kohane, a Harvard endocrinologist, and co-author of a recent book The AI Revolution in Medicine: GPT-4 and Beyond writes “How well does AI perform clinically? And my answer is, I’m stunned to say: better than many doctors I’ve observed.”
Just think, with my phone connected to a wrist band and having all my medical and health data, an AI bot could monitor me in real time, offer a diagnosis, contact my pharmacist with the prescription, and delivered by Skip the Dishes, possibly even before I feel ill.
Not meaning to discourage the record number of new medical students admitted to the University of Manitoba medical school, but AI will completely disrupt health care. Within the next decade, family physician shortages will vaporize.
AI coupled with diagnostics offers me the agency to manage my health, without intermediaries delaying the process. Certainly, the need for human care will remain, but inevitably the locus and control of healthcare will shift to the individual or in other words, the private sector.
Gregory Mason is an associate professor of economics at the University of Manitoba.