The law of unintended consequences

Perhaps you remember when infant safety seats were mandated to be placed in the back seat of the car not in the front passenger seat. Made sense, right? So why did this action lead to a dramatic increase in child injuries from automobile accidents? The unintended consequence of the law was to cause parents to turn around while driving. Less attention to the road, more accidents.

The Affordable Care Act of 2010 is intended to bring about cost reductions on many levels in health care, and part of that is helping patients see clearly into cost and quality matters. The intended consequence of health care Transparency is to help consumers choose low-cost high-quality providers. But what if consumers believe more care is better and low cost means low quality? It's another great example of how our assumptions don't always lead where we expect them to go. 

Unintended consequences don't always mean the original thought was a bad idea. They remind us that change is more complicated than we anticipate, and the more so when many people are required to make changes. It's why public comment periods and the democratic process are so valuable in bringing about a better end game. I personally get impatient with the review process, the criticism, the debate but I have to admit it produces better results.

As we observe the transformation of healthcare over the coming years from fee-for-service to pay-for-performance and from disparate care to connected care, let's take the long view. Give yourself time and space to test assumptions and adapt, and do the same for those who are driving the bus. 

Alistair Jackson, M.Ed.
For some deep and interesting insight on this topic, see the article published on Health Affairs as "Consumers’ And Providers’ Responses To Public Cost Reports, And How To Raise The Likelihood Of Achieving Desired Results" by Ateev Mehrotra, Peter S. Hussey, Arnold Milstein and Judith H. Hibbard.