Juha Teperi: Prisoner of words?

The name Michael E. Porter will be familiar to everyone who knows something about business management. More than sixty editions of the most popular bestsellers written by the strategy guru have been printed. Words such as clusters, competitive forces and competitive advantage have crept into the language of laypeople too, and all are concepts that have been raised by Porter.

Porter’s qualifications as a theorist on competition and as a business management thinker are certainly well know. It seems to be less well known in Finland that the Professor of Harvard Business School has been carrying out research on health care for several years. Redefining Health Care (HBS Press), which was published in 2006 (together with Elizabeth Teisberg), presents an illuminating analysis of the forces that control the functioning and development of all health-care systems. The book’s general message is clear: all health-care systems should ensure in a new way that the operations produce as much health as possible. If the common objective of all the actors is not maximising the health benefit received by the patient, the situation turns into a zero sum game that is detrimental to the patient.  

The two key concepts in Porter’s thinking are competition and producing value. The basic concepts, which have become established within the business world, appear, however, to have gained new dimensions since people have started to use them in the field of health care. Many health-care professionals consider that the words have a rather harsh business ring to them. The expressions, which had been perceived as positive without any problem in many other social sectors, seem to be transforming and becoming unclear if not completely negative: money rules and the weak get trampled underfoot…  

It is a foregone conclusion in Porter’s thinking that the value produced by health care is the health benefit that the users of the services receive. The right kind of competition in health care is competition as to who can use the limited resources best of all to create health. This is not a question of tendering or privatisation: if anywhere, this right kind of competition is needed within public service production.  

Porter and his colleagues have created the ideal model of “value-based health care”, in which the incentives for all the actors are directed in the same direction – increasing the health of patients. This creates a situation where everyone is a winner: organisations producing health efficiently succeed, the payers get their money’s worth and most important of all, the health of patients improves.  

Porter’s message is clear: in current health-care systems there is too great a focus on money, and the objective is to minimise costs. In place of money, the health benefit created with it should be monitored, whereby the situation of those in a weaker position will also improve.  

How do we switch over to value-based health care? Porter does not have a single clear solution for this. Neither can there be: practical conclusions and measures depend greatly on the starting situation of each health-care system. Therefore, common sense must prevail in every country or system and the most appropriate actions sought.   It would be tragicomic if “creating value” and “competition” as words were to result in health-care experts distancing themselves from Porter’s ideas. He is, after all, challenging us all to break the gaze fixed on euros. The issue is so important that we cannot afford to become prisoners of words.    

Juha Teperi
Programme Manager, Ministry of Social Affairs and Health