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By Amr Mohamed Alsayed Metwally, Architect
Early last year when international media reported of a nationwide strike exploding into violence and leading to shutting down of roadways, setting up of barricades of burning tyres and blocking access to airports that eventually necessitated the use of teargas by security forces to maintain order, very few suspected or could believe that the protests that had erupted was happening in the city of Paris in France. The rioters were the taxi unions and the furious taxi drivers were protesting over competition from non-traditional car services such as Uber, leading to widespread chaos across the country.
Launched only seven years ago, Uber Technologies Inc. is an app-based transportation company headquartered in San Francisco, California. It operates in about 270 cities and more than 60 countries worldwide and with over 40 million trips on ride-sharing services monthly, it is currently worth over $50 billion and considered to be the first viable startup of its kind in the world.
Uber has upended the world’s heavily regulated taxi industry. In recent months, there have been protests against Uber in many countries across the globe and recently, the governments in Spain and Italy have banned the service.
Historically, the taxi marketplace has been characterised by significant economic regulation, such as restrictions in the fixed number of taxi medallions, special license requirements for drivers, and other regulatory barriers to entry. However, despite all these, the ride-sharing platforms managed to achieve market penetration by reducing connection costs for drivers and riders and providing innovative pricing services such as real-time, consumer demand–driven pricing. In simple terms, they succeeded in closing the existing market gap and solving the public transportation problems which, in turn, has contributed to a decline of the public transportation industry in many countries.
Similar to Uber is the example of Airbnb taking on almost the same role but in the hospitality sector. With 100 million booking yearly and $30 billion worth of capital, it is the second viable startup in the world after Uber.
Uber and Airbnb are being touted as the 21st century answers to the community that have an appetite for the on-demand delivery model. By optimising their assets – human, physical and intellectual resources, and combining it with the technological capacity for rapid cost and service in a very transparent two-way exchange model, the “sharing economy” or collaborative consumption that has thus emerged is well-suited to entrepreneurialism in public sector delivery models, including in healthcare.
As an emerging industry, it was but natural for the sharing economy to target the healthcare sector. For instance, Uber capitalised on the vaccine market with its flu-shot initiative that successfully turned the traditional model for vaccinations upside down. The same can be replicated with other vaccinations, tests or preventive screenings.
Can the Sharing Economy Enhance Current Healthcare System?
Two things are currently happening in healthcare that position the industry for sharing. Changes to how and how much providers are paid for delivering care are driving provider strategies focused on consolidation and economies of scale; and technology has advanced itself to the end of making sharing not only possible, but seamless.
Now, there is a mass of mobile app developers that make use of the sharing economy-based care model. ‘Pager.com’ for example, has reinvented the traditional doctor house call by allowing users to see a doctor within two hours in the patient’s home with relatively low cost and with the added benefit of dispensing with the normal frustration experienced in the waiting room.
Another example of the use of sharing economy in healthcare is through providing medical equipment through a model of ‘access instead of ownership’. Purchase of expensive and advanced medical equipment often leads to situations where hospitals are found to be operating under capacity. Hospitals use any given machine only about 42% of the time, at most, according to a GE Healthcare study. Boston-based technology startup, Cohealo, is enabling hospitals and health systems to share medical equipment across facilities, so they can optimise spend, accelerate cash flow and improve access to care. In simple terms, it means they are aligning underused supply with customers via a simple, easy interface. Hospitals using Cohealo are saving anywhere from $1 million to $2 million in the initial stages, and that total multiplies the longer a hospital uses the system. Hospitals could find up to $5 million to $7 million in savings, based on Cohealo’s data analysis. In 2015, Cohealo was named in the top 10 innovative companies in healthcare as it helped hospitals fully utilise their most expensive assets.
In the field of diagnostics too, sharing economy models are emerging both for clinicians and for their patients. Toronto-based Figure 1 is a free mobile health startup and peer to peer network that is used by healthcare professionals and healthcare students. Currently with more than one million users, Figure 1 allows users to browse cases by anatomy and medical specialty to seek input on complex cases by posting relevant images and information while maintaining the privacy of the patients.
Following a similar concept but offering the power of a patient network is PatientsLikeMe.com which operates under the vision: “Let’s make healthcare better for everyone through sharing, support and research.” This has fostered a peer coaching culture that allows patients to share stories of symptoms, treatment info, and health outcomes. The data thus provided enables the industry to undertake real-time research to innovate or develop better products, services, and care. Apart from sharing information that could pave the way to pathbreaking research, registered patients can also improve their knowledge about their medical issues and improve their outcomes by connecting with and learning from others who have gone through similar experiences.
The rise of telehealth platforms, which present a variety of unique benefits to both consumers and physicians. represents a new frontier of the sharing economy. Patients may seek telemedicine services for episodic care, specialty management of chronic illnesses, and primary care. Consumers stand to experience increased convenience in accessing medical services and encountering a variety of connection services platforms, choosing the modality they prefer based on their own unique characteristics as consumers. Currently, telehealth platforms have the potential to disrupt the market for medical care delivery causing the same effect that Uber and Airbnb had on the transportation and hospitality sectors respectively.
Sharing Economy Forcing Decentralisation
As the above-mentioned ventures aptly demonstrate, the Sharing Economy models are bringing decentralisation to the current healthcare system and this will inevitably lead to replacement of large, centralised healthcare institutions, or force them to change. We may not have guessed just a decade ago that the Sharing Economy model would lead to dramatic changes in the healthcare ecosystem that we were familiar with, but that day is upon us now. It is therefore rather surprising that health policy in several nations continue to be formulated without any reference to this expected switching of models.
World of Denial
Similarly, today in the Middle East - after many years of denial due to the misperception that the model cannot be applied in the Arabic world due to culture issues, we find that societies have reshaped many of their traditions to successfully adapt the sharing economy model in their daily lives as they see the benefits out of it. These winds of change will certainly extend to the healthcare system even if more slowly and cautiously than in the rest of the world.
How long will it take before recognition sets in that building medical cities might not be the right business model anymore, and that we have to steer clear of traditional ways of design to adapt to the new model? The consequences of shifting from a traditional to a fully or partially digitalised model of care comes at a tremendous cost, especially when implemented at a later stage.
Eventually, there are more questions we should start asking ourselves in order to get ahead of this wave of change. As has already been shown in the worlds of transportation and hospitality, consumers will eventually switch to a better service whether the regulators are prepared or not.
Sharing Economy will reduce costs and improve healthcare, particularly its accessibility. Our goal should be to help accelerate these changes first by identifying them and driving awareness, and also giving them a context and framework so that new models can be developed more rapidly. The important step to be taken now is to change the way of designing and thinking about our healthcare facilities in the light of the emergence of these new models of economies.
It is time to stop debating about whether the sharing economy will affect our healthcare ecosystem or not, as this is an undeniable solid fact. It is time instead to discuss what happens after the change occurs like community-driven health, and how we can regulate it to ensure quality and privacy. We also need to think about the new data ownership rights and how we can provide our patients with full access to their medical records without hampering their privacy.
The time to adapt to the change is now; before we find ourselves protesting against new competition in much the same way as the taxi unions did in France.