The competition conundrum
Why our inability to have robust competition in mental health works against our drive for change
This past week was soccer tryouts in the Miller house. For those who have experienced this rite of passage, you know how tense this time can be. You have to show up early, assess the other players, get in the right mindset to be your best, and get ready to perform. And that’s just the parents! In all seriousness, soccer tryouts, however wild and wonderful they are, remind us that there are varying degrees of talent, and we have to work hard, to train, to be the best person to make the cut, and ultimately join the team.
Usually when we think of competition, we think of either sports or business. And for good reason. Competition in business has a profound impact, driving innovation, customer focus, and price optimization. To stay ahead and stay relevant, companies must constantly innovate, enhancing products and services while improving their overall efficiency. The customer? Well, our satisfaction becomes paramount, prompting businesses to listen, adapt, and offer unique value. We get to have a say in what products we buy based on the price, accessibility, quality, and so much more. All of these factors go into how a business thinks about being competitive in an often crowded market.
Competition can be good for business and ultimately the consumer, but what about other sectors like science? I read an interesting article that discussed the impact of competition on scientific research, specifically in the field of structural biology. As an academic, many of the themes they highlighted resonated like how competition can lead some to rush to publish findings, which can potentially lower the overall quality of scientific work. The article also highlighted the growing concern that increasing competition in science may hinder scientific progress, promote secrecy, and lead researchers to cut corners. Overall, the paper really spoke to the need to balance competition and collaboration in scientific research to ensure high-quality outcomes.
What about competition in the mental health field? We already know that for most individuals looking for help, there are limited options. It’s hard to have competition where people can’t easily discern between the various products, their cost, and what they get from the services they are buying.
But before we get more into mental health, let’s talk about competition in health care for a second.
Dr. Elisabeth Rosenthal, a physician, journalist, and author, argues that competition doesn't work effectively in health care in her book "An American Sickness: How Healthcare Became Big Business and How You Can Take It Back." I refer to this book often, and encourage you to check it out because it points out how market forces like competition don’t really work in health care like they do outside of health care. Here are a few examples from her work as to why this is the case.
Lack of Transparency: In many health care systems, prices for medical services and procedures are often opaque and impossible for patients to understand. This means that we, the patient/consumer, can’t make informed decisions or compare costs. Without price transparency, competition just can’t function effectively.
Information Asymmetry: Health care providers typically possess more knowledge and information about medical procedures, treatments, costs, and outcomes than patients. Strange huh? Our lack of information puts us at a major disadvantage when making decisions, reducing our ability to shop around, or even know what to shop around for.
Misaligned Incentives: Fee-for-service payment models, where providers are paid for each service or procedure they perform, can create perverse incentives. Instead of focusing on patient outcomes and value-based care, providers may be incentivized to increase the volume of services provided, leading to unnecessary tests or procedures and driving up costs.
Complexity of Health care: Because health care is a complex field with numerous stakeholders, including patients, providers, insurers, pharmaceutical companies, and government entities, the intricate interplay between these entities makes it challenging to establish and regulate effective competition.
Now, it’s hard to see where everything I said above doesn’t also apply to mental health as it does. In fact, some might argue that mental health is even more opaque than general medical care because of our traditional views on siloed data and privacy/confidentiality.
But I don’t want to give up on pushing us to be better. Dr. Rosenthal argues that instead of relying solely on competition, health care systems should focus on addressing these underlying issues by promoting price transparency, improving access to information, encouraging value-based care models, and implementing regulations to prevent market consolidation and promote fair competition. This sounds great, right? How do we make this happen and would it benefit the mental health field?
One interesting study looked at increasing competition for mental health. Researchers found that while some reforms have been used to encourage competition in the private sector to improve mental health services, there remains a limited understanding of how mental health organizations actually experience and respond to competition. The study also found that while mental health organizations do compete for qualified personnel and make adjustments that may enhance services, the promised performance gains of privatization may not materialize due to minimal competition for funding and utilization of services. Similar to what I mentioned above, this lack of competition is attributed to factors such as market segmentation, policies expanding treatment access, and high community demand.
If we can find a way to increase competition in the mental health field, there are a variety of positive effects that we might see, including:
Innovation and Improvement: Competition can drive mental health practitioners and organizations to develop innovative approaches, therapies, and treatments. It encourages professionals to stay updated with the latest research and advancements in the field, leading to improved services and outcomes for patients. It also may force some to rethink their structures and reassess where they show up to deliver care.
Accessibility and Affordability: Conceptually, competition could increase the availability and affordability of mental health services if we had the ability to increase the number of providers out there. On paper, the more providers that enter the market, the higher the likelihood a wider range of options for individuals seeking help are available, which leads to potentially reducing wait times and increasing access to care.
Quality Assurance: Competition should incentivize mental health providers to maintain high standards of quality and professionalism. If we had data that would allow us to compare apples to apples for provider outcomes, we could look to choose who we saw based on the quality of care they delivered! How amazing would that be?
I think this issue of competition limits our ingenuity and creativity in the mental health space. While some tech platforms have introduced new approaches that disrupt traditional delivery models, I am not sure that’s enough to bring forward radical reform. Being conscious of what doesn’t work, we should look to continue to strive to increase the quality of mental health care in this country and a major piece of that will be based on our ability to choose who we see, when we want, and at a cost we can afford. Right now, that’s an aspirational dream.
And yes, we made the team!
Success is the result of design and desire in both soccer or business. Competition makes everyone better.