The breadth and, frankly, the dispersion of Harvard groups who have a say in the health care management field are emblematic of the situation elsewhere. Medicine attracts a host of researchers and thought leaders, whether because of the brushes with life and death, the roughly three trillion dollars at stake, or a bit of both. Several options await the medical student seeking additional know-how for building a better health care system, including the master’s in public health, master’s in public policy, and master’s in business administration. The choice is highly personal, often driven by first impressions and the not-unbiased advice of alumni. What is one to do?
Breaking It Down
One way to navigate the waters is to categorize health care management groups into the policy and business sides.
The policy area is, perhaps, most familiar to readers at the Medical School and affiliated hospitals. The growth of government-sponsored programs such as Medicare and Medicaid, alongside research funding through the National Institutes of Health, pegs policy decisions as the key influence on both delivery and discovery. Research that informs policy plays the same role as that reported in the major scientific journals. The intellectual disciplines of epidemiology and statistics provide insights into the health of populations and suggest simple yet subtle ways to grow healthier communities. Since clinicians feel the immediate effects of changing laws and rulings, policy offers a pragmatic lens to predict who will benefit and who will get the short end of the stick.
Lastly, the moral anchor of medicine implies a social contract between professionals and the public. And though physicians aspire to ethical ideals beyond the imperfect compromise of law, policy remains one of the best tools available.
The business world is likely less familiar to a medical audience, save for news from the cohort of medical students venturing to participate in the new MD–MBA program. Even when recognizable, private enterprise in the health care sector frequently is tinged with a pejorative hue, from (big) pharmaceutical companies to concierge physician practices. But business offers a set of fundamental skills, tested by the fires of competition and the potential for widespread impact. Expertise in accounting and finance enables the creation of sustainable organizations.
Particularly when resources are constrained, as in the present health care environment, robust resource allocation in concert with strategic action can facilitate steady growth. The private sector demands discipline, since bankruptcy is a real possibility when creditors demand payment. Managers in market-oriented organizations, from the middle to the top, spend a great deal of time figuring out how to align and motivate employees and other stakeholders, placing special emphasis on maximizing the performance of teams.
It is unclear when policy and business took their vows at the altar of Hippocrates, but such is the case in the partially public, partially private American health care system. Virtually every article on the state of health care pronounces the system a mess using one of a handful of synonymous adjectives: fragmented, convoluted, Byzantine. It’s well passed time to fix this unsteady marriage, to find ways to build a successful relationship between public policy and private enterprise within medicine.
The Path to Partnership
When they get down to brass tacks, most Americans look to government institutions to address health care woes: whether Medicare Part D to negotiate lower prescription drug prices, the U.S. Food and Drug Administration to vouch for the safety of new products, or Medicaid to aid the most underserved patients. Public policy by definition is inclusive, at least considering a broad range of stakeholders. Yet the flip side is that by serving too many masters, the final versions of laws and regulations fit no single group very well.
The major shortcoming of public policy, however, is execution. Health Affairs presents fabulous ideas and insights from cover to cover, but most of them collect dust on the shelf. The political process, incremental by nature, stifles genuine innovation and requires the tax of compromise. Add in acrimonious relations between Democrats and Republicans, and health care bills seem destined to meet an inglorious fate.
How can business help? Simply put, it can get things done. Business plans might not be high-brow literary fare, nor based on a rigorous scientific method, but they are keenly adept at turning half-baked ideas into reality. Private enterprise has a history of just-in-time responsiveness, anticipating and responding to change. Business leaders recognize that money will not necessarily fill the coffers of good, even noble ideas; they do not bank on the hope that “if you build it, they will come”; rather they find margin to fund the mission. Finally, commercial organizations understand how to incentivize stakeholders to fulfill short- and long-term strategic visions.
Regardless of which side a medical student chooses, he will be a better doctor and health care manager only by understanding the other side. Corporate ethics scandals and the pitfalls of mortgage asset–backed securitization provide another warning about the indispensable role of statutory safeguards and the limits of competition. Public–private partnerships are something of a buzzword, but the unique challenges and opportunities for the American health care system are serious business.
Jason Sanders, HMS ’08, is starting an internship in internal medicine at Massachusetts General Hospital.
