Luddism comes in many forms. Even a well versed and articulate argument put forward by medical professionals to stop people filling in a survey. You might say an analogy between modern-day brain surgeons and Victorian textile workers, is pushing it, but the results are the same. Social and economic progress is stymied by a narrow interest group resisting technological or procedural change, and that is precisely what the resistance to tranparency and performance measurement in healthcare represents.

Outcome measures, where the results of medical treatment are carefully collected, analysed and often published, are now supported by a wide range of actors. And are being used effectively by operators, like the German not-for-profit, Martini Klinik, to grow their businesses. When we spoke to its CEO, he bemoaned the role of the medical profession in resisting increased transparency. But it is not the only culprit.

Purchasers are also guilty we hear. Another CEO of a leading Irish private hospital, tells us it receives no extra money or referrals despite publishing evidence of superior outcomes. “At the moment, I’m not sure the purchasers are taking much notice,” he said. And it is expensive to gather the data and liaise with surgeons and requires sophisticated data entry software. Martini pays six full time staff to do this job.

This may be about to change, however. James Cercone, president of the consultancy firm Sanigest Internacional, says Europe is far behind the curve. You may not see payers making those decisions here, but 1% of US Medicare reimbursement is already subject to value based outcomes; performance measures are being used in hospitals in Brazil; and there are numerous other examples across Latin America and beyond.

The lack of public healthcare systems across emerging markets has led to a different culture when it comes to purchasing treatment. If you are used to paying for healthcare, you are probably used to making the necessary steps to make an informed decision, and will be a more demanding consumer. The evidence from these markets suggests private individuals may have taken the lead, where insurers and European healthcare systems are lagging behind.

No chance of replacing doctors

A different angle to the luddism debate was presented in some new research released last month. A study by Carl Benedikt Frey and Michael A. Osborne from the University of Oxford predicts that medical professionals are some of the least vulnerable workers to computerisation. The Future of employment: How susceptible are jobs to computerisation? places the probability of computerisation for physicians and surgeons at just 0.42%!

So what’s this about luddism then? Well it seems that computerisation is not a threat and these results are good for doctors and other healthcare workers. The stock answer regarding technology in healthcare is that it does not replace doctors, but complements them. These results support this prediction. In any case, the most efficient operators appear to be industrialising healthcare without removing the doctors; instead they reduce them to more routinised roles.

Yet some might suggest that the next stage to routinisation is mechanisation: not long after artisans were shuffled into factories, the mechanised loom shuffled them out again. And the hospitals of Narayana increasingly resemble factories. The chances of that happening may remain slim. However, the role of medical professionals and their place in the healthcare system will certainly evolve due to a combination of technology, task shifting and changes to education.

Outcome measures, on the other hand, are clearly not a threat to medical jobs across the board. Their effect is distributional. The worst performers will be weeded out and the best rewarded. This may increase the pressures on the profession, but the same pressures the rest of us are already subject to. Issues of misinformation and the perverse outcomes of marketisation are valid, but manageable. I repeat: luddism comes in many forms and refusing to open up a profession to scrutiny is equally pernicious.