How Will the Internet Change Our Health System?
Powerful though the Internet may be, its impact on health care will continue to be tempered by privacy concerns and professional resistance.
BY JEFF GOLDSMITH
HEALTH AFFAIRS - Volume 19, Number I
Those who make their living forecasting change in social institutions are frequently humbled by the actual flow of events. Developments that seem inevitable (such as "artificial intelligence" or the picture phone) seem to take forever to happen, while seemingly unstoppable institutions or innovations (such as physician practice management firms) suddenly collapse. Sometimes, however, innovations spring, fully blown and unheralded, seemingly from out of nowhere. The Internet is one of these.
Although health care institutions may resist the influence of network computing, eventually, the Internet is likely to accelerate the "virtualization" of health care plans and systems and help to eliminate much of the clerical burden in caregiving and insurance. The core processes in health care -- interactions between physicians and patients -- are likely to be rapidly and profoundly affected.
From its not so humble origins as an experimental, Defense Department funded, secure data network, the Internet exploded during the late 1990s into a powerful new social institution. The adoption curve for the Internet is far steeper than that of any of the established media: Although it took radio thirty eight years and television thirteen years to reach fifty million users, the Internet reached the same number of users in only five years. According to a 1999 Louis Harris poll,
48 percent of adult Americans about ninety-seven million people use the Internet to communicate with one another and to acquire information, products, and services.1 The Internet is only incidentally a broadcast medium. Rather, it is like a flexible and powerful new nervous system for the economy and society.
One basic misperception of the Internet is that its greatest impact will be in its consumer retail applications. Consumer use is actually only the visible tip of a much larger iceberg. The underwater part of the iceberg business to business electronic commerce is five times larger than consumer-based e commerce and is projected to grow at a far faster rate. According to Forrester Research, consumers spent an estimated $8 billion (out of roughly $2 trillion in overall consumer spending) online in 1998, an amount expected to increase more than tenfold to $108 billion by 2002.2 By contrast, businesses did more than $40 billion in Internet business with each other in 1998, an amount expected to reach $1.3 trillion by 2002. 2 In this paper I examine some of the areas of the health care system that are most likely to be affected by the spreading influence of the Internet.
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