The Future Of Health Care Access

John A. MacDonald, Anita M. McGahan, and Will Mitchell | Stanford Social Innovation Review | October 18, 2013

Traditional health care is a hands-on, brick-and-mortar affair. But across the developing world, a wave of technology-driven innovation signals the emergence of a compelling new model.

For generations, the model of how people in the developed world access health care services has involved face-to-face encounters between doctors and patients in brick-and-mortar medical facilities. The contours of that model are well known: A patient arrives in a clinic, registers her insurance at the front desk, and waits. Then a nurse or an aide ushers her into a sterile room, takes her vital signs, and hands her a paper gown. Some minutes later, a doctor in a white coat enters the room, asks her questions for 10 minutes or so, and conducts a brief physical examination. The doctor issues a diagnosis, writes a prescription, and sends the patient off to make a copayment. Afterward, the patient will drive to a local pharmacy to purchase medication. She is one of 40 patients whom the doctor will see that day.

In developing countries, that model of access is structurally untenable. According to the World Health Organization, there is a global shortage of 4 million health care providers; in 57 countries, by the WHO’s reckoning, that shortage amounts to a “crisis.” 1,2 The WHO also estimates that 30 percent of the world’s population lacks access to essential medicines.3 Rural clinics in the developing world are scarce and ill supplied, and using better-equipped urban medical facilities often requires patients to make a two-day journey. Even within cities, travel to and from a clinic through jammed streets can take several hours. Urban clinics, moreover, are typically overwhelmed by patient demand. Alternative providers such as local pharmacists are well meaning, but they tend to have limited training. In place of insurance, people must rely on family savings to cover health care expenses. Medications are often counterfeit, serving as placebos at best and causing considerable harm at worst. Across large swaths of the globe, a lack of supporting infrastructure and appropriately trained personnel undermines any hope of replicating the Western model of health care.