Healthcare reform can't overlook regional culture


Some of the most innovative ideas in the healthcare industry may only thrive in certain markets, geographically siloed in a way not unlike the French wine industry.

The phenomenon is comparable to “terroir,” which explains why certain types of grapes for wine can only grow in certain regions of France, according to a Health Affairs blog. Much in the same way, according to the authors, certain healthcare ideas may only flourish in distinct regions. There are huge cultural differences between different parts of the country, according to the authors, which can lead to wide variation in how healthcare is delivered.

“In our experience, there seems to be almost nothing except Medicare that is truly national about our health system,” the authors write. “Fort Lauderdale, Florida, Hastings, Nebraska, and Seattle, Washington are actually in different countries culturally and politically. Those significant cultural and political differences have economic and historical roots, and uniquely color the traditions of medical practice and health care organization that prevail in those communities.”

The authors offer the example of Kaiser Permanente’s provider health plan, which was mostly taken hold in its base on the west coast. Of its 10 million-plus enrollees, about 82 percent live in either California or Oregon, according to the blog. Kaiser has made enrollment inroads in other regions like Hawaii, the District of Columbia and Denver, according to the blog post, but large-scale attempts to become a national insurance powerhouse ended in failure.

The authors suggest that a possible solution to account for these regional variances is to look beyond economics for health policy reform suggestions. Such models “play out unevenly” in different parts of the country, the bloggers write, despite the industry’s fascination with them, and so may not be the most effective means of reform.

A failure to include regional differences can severely undermine potential “national” health reform initiatives, according to the blog. “Absent a respect for local and non-economic factors, we will continue the wasteful practice of sowing our policy seeds on barren ground,” they write.