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Martin Odber

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Can the shortage of doctors be solved using an adaptation of the third law of supply and demand?

The third law of supply and demand states "If demand remains unchanged and supply increases, a surplus occurs, leading to a lower equilibrium price."
( http://en.wikipedia.org/wiki/Supply_and_demand )

If we increased the rate of new doctors entering medicine (using mechanisms such as but not limited to; subsidizing doctors education, further compartmentalizing aspects of health care etc ) until we reached a surplus state then would waiting times and the cost of healthcare go down accordingly?

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    Sep 6 2013: Hi Martin,

    I think your approach would work, but there are a lot of assumptions:
    1. the supply/demand paradigm assumes rational actors - we try to be rational, but it doesn't always work out.
    2. you are dealing in a market that has significant demand manipulations - promoted demand distorts natural demand.
    3. you have supply-side constraints. Some of which are irrationally driven (prestige, in-fighting)
    4. deep seasonality.
    5. Frequent outliers (disasters - natural and man-made. epidemics)

    With all the noise in the healthcare "market", I think one needs to concentrate on versatility/adaptivity before manipulating supply-side.
    One major advance to the solution might be to stop constraining the issue in market terms.. perhaps more emphasis on social capital would help increase scalable response-times? For instance, an increased level of nursing education in the general community might establish a reserve resource to address the variability and increase service levels without increasing narrow cost constraints. Having a higher healthcare ambience in the community might result in higher take-up rates for specialised professions?
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      Sep 6 2013: Hi Mitch!

      Great to hear from you again.

      Mitch, please forgive me but some of that went right over my head.

      To paraphrase I think you might be saying rather than focus subsidies on introducing more doctors into the system, increase medical spending towards employing more staff in key area's below doctors so the money would go further and the services end would expand more readily.

      Is that correct?
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        Sep 6 2013: Hi Martin,

        Sorry for the jargon! I spent about 16 years working on supply/demand systems with a focus on demand forecasting.

        What I'm saying is that there are 2 economies - the exchange economy and the social economy.
        In the exchange economy, there is no value residue after a transaction beyond interest/usury.
        In the social economy there is a large value residue that is generated as a commons. This is equivalent to surplus from human labour.

        If you increase the commons component of value, it serves as a "buffer" and allows the economy a larger margin to absorb shocks.

        So the suggestion is to have nursing and healthcare skill educated throughout the community as a social investment. That way, healthcare shocks can be absorbed by having a "reserve army" of volunteers plus a greatly enhanced first-aid capacity. The secondary affect is that the increased awareness of healthcare issues would induce greater uptake of people entering medical professions. This would induce your supply-side balance without directly manipulating funding arrangements.
        The danger of directly funding supply-side is that it creates a pool of money - that attracts exploiters before it attracts the truly "called". It results in a quality downgrade in medical professions.
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          Sep 7 2013: Mitch,

          I can see some good logic there, but ..there's always a but isn't there? I have to question how many steelworkers, waiters, and people from all walks of life already stressing from trying to get through their busy days, would be eager to sign up to take night courses in nursing/healthcare .. so they can volunteer them to the community. Alot of people that finish slaving all day just want to get home to their families and enjoy some downtime, don't you?

          On the other hand, what specific skills do you see in those area's that could alleviate the reasons people commonly see doctors enough to significantly reduce wait times?

          After all, we could always include a new "mandatory" class in schools that would see every citizen learn a reduced set of medical skills if it would benefit them strongly enough to be worth the cost and effort.
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        Sep 8 2013: Hi Martin,

        "but"? yes, nothing is simple. Or rather - things may have simple roots, BUT become complex very quickly.

        The situation with people not having any time is another subject .. I could go on at length about that, but I'd better not .. personally, I have tons of time .. that took a lot of strategy to achieve. Most who can engage with TED conversations have a lot of time, for one reason or another.

        I'd see the raising of healthcare skills best served by getting first-aid taught at the youngest age possible. At the moment, that means schools, but it could be done other ways. Whichever way, it doesn't matter. By getting to the youngest, it propagates to their parents and spreads-out. From there you might see some reform to the liability laws that currently hamper a lot of civilian intervention - as is seen in things like road-accident cases where everyone slows-down to look, no one stops.
        It's an awareness thing.

        If you follow modern neuro-science, you will see that "framing/priming" has powerful affects on the way people perceive and react to things. That's where "ambience" becomes important.

        Specific skills? .. common diagnosis would help .. how to take a pulse, get a blood pressure, check common signs, and how to recognise the need for specialised help. THis is already a factor - things like CPR, the Heimlich manoeuvre etc already have some degree of traction - these, as a start, could begin the process if they were formalised for the whole community. You could go on with some of the more common nursing practices. There might also be some relaxation of the prescription laws - if a person holds a certificate of diagnostic skill, they might be granted a small range of prescription - so the operation of basic drugs could be educated - simple things that work, like anti-biotics, analgesics .. dressings .. basic stuff.
        My sister is a chief nurse-educator in my state's healthcare system, my brother in-law is the nurses' union leader. Perhaps I could ask them?
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          Sep 8 2013: "My sister is a chief nurse-educator in my state's healthcare system, my brother in-law is the nurses' union leader. Perhaps I could ask them?"

          If you would include them yes that might give us some valuable insight. With responsibility comes accountability and if any wrong decisions were made it could cost lives. One would always want to err on the side of safety yes?
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        Sep 9 2013: Risk is a very interesting concept.
        If you take too much, you fail, if you take none, you fail.

        With policy comes discretion. Unfortunately, lawyers do not like discretion. And discretion is the birthplace of corruption.

        Wrong decisions will always be made. It is the nature of risk. Accountability is determined by winning more than you lose.

        This is where "ambience" becomes so critical - our culture has drifted into an ambience of unreasonable intolerance.

        Healthcare begins with empathy - empathy leads to compassion. All that is needed is to emphasise the critical role of compassion - and give it some tools. This is a cultural task - customs of compassion will certainly find the tools for expression if they are allowed to.

        There is evidence that a compassionate culture has less health problems. So perhaps your supply/demand question could be solved by abandoning the supply/demand ideology?

        I will ask my sister what she thinks. My Brother in law will be un-reachable right now, the fascists just took power in Australia - and the unions will be very busy planning their survival.
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          Sep 10 2013: I do not know that abandoning the supply demand ideology is a valid option that we can reasonably achieve at this point in politics?
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        Sep 11 2013: Hi Martin,

        In the realm of "serial binary transaction" supply/demand is solid (give or take the inherent instabilities of scarcity/distribution). However, when you are dealing at the tribal/community level, it stops being binary. It becomes massively parallel and networked.

        I'm not talking about abandoning the supply/demand "market" *method* .. I'm talking about the supply/demand *paradigm* .

        When blank "market forces" are the total definition of the paradigm, the solutions you are looking for cannot be found.

        I am suggesting that the paradigm be widened to include the type-2 social economy.

        For instance, we use the "insurance" concept to comprehend healthcare outcomes.
        It's a reasonable good concept. But it has a flaw - insurance, at its base is risk-shifting when applied to market forces, but when it is applied to the social economy, it is risk-sharing. Healthcare is a social investment - and insurance applied to it is risk-sharing.
        When you indulge in risk-shifting, you export your risk to "dupes" - this is what the commercial insurance industry does .. it's rarely presented that way .. but a wink-and-a-nod can make someone else suffer your risks for a small fee.
        When applied as social insurance, it is an investment in social strength and productive potential.
        This is the basis of the "welfare state" which is currently being demonised as a prelude to pillaging the latent social value stored within it. That's our lifeboats being sold as firewood.

        No, don't abandon the "market" method - simply subsume it into a more honest framework. To do that, you need to have a serial+parallel paradigm - and know which side of it is appropriate.
        I use insurance as one example - there are others.

        (I note that that insurance began as a confidence trick - Having worked in the insurance industry, this is well known in those circles)
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          Sep 11 2013: Hi Mitch,

          In general I believe you feel we can apply risk shifting to various factors of the financial (and or logistical) requirements of an enhanced health care system to downgrade costs and upgrade efficiency if I understand you correctly.

          More than one of our other contributors suggested shifting the risk with regard to logistics by training and empowering people to perform a doctors more mundane functions, freeing the doctors up to focus on the more complex aspects of care.

          Others have suggested educating the public itself in prevention methods and first response techniques to lower the amount of professional health care required.

          Yet others have suggested creating private foundations to offset new doctors educational costs.

          Are these some of the specific approaches your serial+parallel paradigm might embrace?
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        Sep 12 2013: Hi Martin,

        Yes, these are good examples of what an expanded social paradigm might do.

        I particularly enjoyed reading the Cuban perspective (below).

        With the expanded social capacity enabled by the internet, There is a growing pressure for institutions to move towards a serial+parallel paradigm. The incumbent interests all reside in the serial economy. Most governments (states) understand the need for social investment, but are fighting a losing battle because they do not understand the world in these serial/parallel terms.

        I have been examining the divide between social and financial capital for many years now and am now beginning to identify the conceptual tools required to comprehend the issue. It's early days, but I think these tools can evolve such that they will spread globally.

        1. There are 2 economies. The financial economy cannot be successfully applied to collectives such as tribes or states - tribes/state must operate in the social economy.
        2. Secondly, the 2 economies can be clarified by separating financial/social, serial/parallel, binary/analogue etc.
        3. It must be understood that the serial financial economy is not intended to yield a transaction residue - any residue imposed on it is usury and will increase wealth imbalances. On the other side: a social economy is intended to yield transaction residue - this residue passes into the commons.
        4. Insurance is a criminal act when applied to the financial economy, but is an important factor of the social economy.

        By using these tools, you can understand the root-causes of social issues.

        Underneath all of that is the notion of "property" - the only thing a human "owns" is their agency. If the principle of property was understood this way, there would be no crimes of dispossession or liberty.

        These things can evolve politically - but only if the basic principles are understood by all.

        I have learned a lot from this conversation - many thanks!
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          Sep 12 2013: You know Mitch, I really enjoyed the read too. I'd not hazard to think I understand the nuances as well as you, but none the less I feel it has advanced my perception somewhat. Especially the comparison between serial/financial and social economy.

          Honestly though when I thought of financial economy I thought of China with its state owned enterprises vs social economy such as perhaps the US where privatization of social services provides services at a price feeding private enterprise from the social teat.

          I won't say however that I feel understanding those will explain to my satisfaction the root causes of social issues. I feel the root causes of social issues are "to heck with you and here's to me!"

          I'm believing by agency you mean "the capacity of an agent (a person or other entity, human or any living being in general, or soul-consciousness in religion) to act in a world."(wiki) but frankly then I'd have to disagree. A person is not always their own master in this world as forces, or poor health can take even that away. So we don't really own our agency, we rent or lease it. *winks*
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        Sep 12 2013: HI Martin, sorry to go on and on, but it seems productive.

        To me, agency is what an organism does to maintain its existence.
        it's a loop: reality-->senses-->perception-->information-->evaluation-->potential-agency-->decision-->action(agency)-->changed reality (repeat until death). All organisms do this.

        "Heck with you" is a statement of property. It is what happens in a serial economy over time when the parallel economy is downgraded. For instance, it is harder to say "heck with you" to your own mother or your best friend.
        Property relates to the evaluation of potential agency - it arises in competition for scarce resources when evaluation exceeds social options. For instance it is useful to view morality as being the zone where both personal and mutual advantage is served by agency. To act outside this zone is to be "immoral".
        "heck with you" is also what financial economists call "externalities". In the corporate world, it is actually illegal to consider externalities .. but it also fails to recognise that a corporation is a feudal community.

        When I look around, I see no scarcity - I only see a political/economic paradigm that has obsoleted itself.
        In game-theory, the selfish tit-for-tat strategy initially wins-out, but the moralistic forgiving-tit-for-tat strategy overwhelms the selfish paradigm. I am looking to observe how the tribal limits of humans affect the game theory.
        When you apply tribal limits, it seems that large collectives are inherently unstable .. this renders large-scale policy ineffective.
        It seems that a stable tribe has no need of financial economy - but inter-tribal relations certainly do require it.
        Atomising the community into individuals conducting serial transactions is a method of de-tribalizing humanity, but the limits are physical - a human cannot comprehend more than 200 other humans - and this is the stable collective tribal size. Beyond that is instability, and humans will form tribes regardless.
        Tribal stability is the end-game.

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