Can Healthcare Escape the 'Reality TV Paradox'?
Written by Eitor   
Tuesday, April 16, 2019 07:48 PM

How is healthcare like reality television? In both cases, what gets rewarded is not actually what the payer really wants.

In reality TV, the seeming goal is to identify the most talented recording artist or the most compatible couple. But even though that may be the stated goal, the real goal is totally different – viewers and ad dollars.

It’s the same way in healthcare, the thing we reward is not the same as what we really want. The ‘Reality TV Paradox’ happens when the relationship of the actual outcome to what you're measuring may not really be strong.

Preventive cardiology is an example. Although the real goal is to prevent heart attacks and strokes, what do we incentivize? One-size-fits-all algorithms for screening for cholesterol which actually may not be the best idea.  The same can be said for blood pressure targets; there is very little discretion related to them … How do we move away from simply incentivizing one-site-fits-all algorithms for every body?

Cigarette smoking is another area where the wrong thing is being incentivized With cigarette smoking, the thing you care about is the rate of smoking. One incentive was holding all hospitals in a county responsible for the rate of smoking, meaning they would need to cooperated to drive the rate downwards.  The Number One supporter of this initiative was cardiac surgeons, and the Number One opposition came from children’s hospitals. 

This example shows that at its heart, solving the Reality TV Paradox is not only about getting the science right and the incentives right; you’ve got to get the politics right.  It’s just as much about winning hearts as it is about winning minds.