Boomers have marveled at the return of bellbottoms, skinny ties, mullets, and moustaches. Memories of misspent youth, suddenly became exciting trends for the generations that followed. Now we’re discovering that the process of rejuvenation applies not only to fashion, but business models too.
Take, as examples, the kid across the street who cut your grass in the idyllic days of the Cleavers, hitch-hiking (a staple of the 60s), or timeshares (a favourite investment of the 80s). A spirit of sharing once drove these services. We had faith in people, penny-pinching grandparents despised waste, and we didn’t mind the grade-schooler not taking debit.
Then things changed. We stopped bowling. Community faded from commerce. Trust, scheduling, and payment didn’t work well enough to make us leverage capacity in the same way we did before.
But like facial hair, community is returning. Task Rabbit gives new life to the 13-year old entrepreneur, Uber is the 21st century answer to hitch-hiking, and AirBnB is the descendent of the timeshare. A cultural appetite for on-demand services, combined with the technological capacity for rapid cost and service variablization, has meant that credible brands have emerged in collaborative consumption and given new life to old habits. This is the “sharing economy”.
An under-appreciated feature of the return of sharing, however, is the impact on government— not only as regulator, but also as a deliverer of public services. Though a strict definition of the sharing economy does not translate perfectly into publicly provided programming, its key principles— creating trust through feedback, community collaboration, scheduling efficiency, asset optimization, and payment settlement— are well-suited to entrepreneurialism in public sector delivery models, including in healthcare.
One early indicator is the resurrection of the house call. These accounted for 40% of medical visits in the 1930s, but dropped to as low as 1% by the 1980s. Now, there is a mass of mobile app developers swarming to revitalize this home-based care model. Pager, for example, is the brainchild of sharing economy pioneer and Uber co-founder Oscar Salazar. It markets itself as allowing users to see a doctor within two hours in the patient’s home, office, or hotel room. Companies like @mendathome, @HealApp, @medicast, and firstlineapp.com deliver similar services and are creating access and price competition. This is a radical decentralization of services and may reverse a decades-long trend towards placing high priced professionals in large institutions so that they have access to expensive technology. As technology diffuses to the consumer, it becomes possible for the physician to, once again, do the same. This decentralization may occur either physically or virtually, and a mix of triage and care systems can be expected.
In 2014, Uber delivered free nurse-administered flu shots to customers in Boston, New York, and Washington. Another company is seeking to enable hospitals to easily rent-out their bulky and unused medical equipment or, conversely, temporality access specialized equipment quickly and without the sizeable expense of purchasing. Again, the ability to decentralize and diffuse expensive equipment and services efficiently, allows for the home to become the site of much more care. Tool sharing and equipment reselling models from the sharing economy could be immediately applied to healthcare and radically change the medical equipment business.
Sharing economy models of diagnostics are emerging both for clinicians and for their patients. Figure1 is a Toronto mobile health start-up and peer to peer network that has created an “Instagram for doctors”, allowing medical professionals to seek input on complex cases by posting relevant images and information. And well established websites like CureTogether.com and PatientsLikeMe.com have fostered a peer coaching culture that lets patients share stories of treatment regimes and generate real-time research networks.
More recently, @Crowdmed has launched a crowd-sourced diagnostic service that uses “medical detectives” to better characterize rare and complex conditions. Case submissions can be made for free or through a variety of paid packages, depending on the service being sought. One can well imagine modern clinics creating virtual diagnostic circles rather than asking wealthy patients to board a private jet to Minnesota or Ohio. Doctors motivated by intellectual curiosity appear quite keen to discuss difficult cases and support colleagues in remote parts of the world on a volunteer basis, and these crowdsourced diagnostic applications appear to be inexpensive to operate. So it’s not difficult to see a virtual diagnostic network that brings the best of western medicine to the child who presents in a nursing station in sub-Saharan Africa or in our own aboriginal communities.
As these ventures demonstrate proof of concept (or not!), the sharing-principle may gather momentum and materialize in models even more explicitly linked to our current conceptions of the sharing economy. How long will it take before hospitals start leveraging their idle operating room and facility hours to generate revenues and improve the timeliness and quality of procedures (AirOR)? We can already request a personal support worker or registered nurse through start-up services like eAdvocate and myPSW. We should expect established providers to emulate these start-ups, just as the traditional taxicab companies have started to emulate Uber. CCACs, for example, may use sharing economy-like services to match patient needs with clinicians and patient support workers.
But if people thought regulating a ten-minute car-share was tough, just think about establishing boundaries in the healthcare world. How do we square understandable cautiousness with an appetite for innovation and the positive cost and quality implications it has? How do we design reimbursement around these services? As decentralization takes hold and more care moves from institutions and medical offices into the home, how will we deal with our overbuilt capacity? How do you manage “shifts” in an organization that is using supply and demand matching systems? Can we trust clinical professionals to self-organize within their scopes of practice?
Admittedly, there are more questions than answers in this article. But we need to get ahead of this. As has already been shown in the worlds of transportation and lodging, consumers will flock to a better service whether the regulators are prepared or not. On early review, the sharing economy has the potential to create opportunities for citizens and caregivers to improve healthcare and particularly to improve its accessibility.
Examples presented in the article above are for illustration purposes only and do not represent endorsements.