What healthcare can learn from aviation security

For decades, every commercial air traveler was asked two standard questions:

  1. “Has your luggage been in your possession at all times?”
  2. “Has anyone given you anything or asked you to carry on or check any items for them?”

Eventually, this stopped after billions of passengers kept saying no. I remember the airlines and/or the Transportation Security Administration stopped asking these questions because they required resources (employee time) without adding to security. I couldn’t find much documentation about this process, so if you find some, please leave a comment.

I wish my doctor’s office would adopt this strategy. I recently had to verify my insurance information and identity three times for a simple doctor’s appointment:

  1. when making my appointment,
  2. upon check-in for my appointment,
  3. with the nurse who took my vitals during my visit,

I realize that my identity needs to be verified at each appointment to insure that my healthcare provider is treating the right person. However, most of the effort seems to be redundant checks to ensure that my insurance information is correct to facilitate billing.

The National Academies released a report entitled The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. The chapter entitled “Excess Administrative Costs” starts as follows.

Administrative costs in the United States consumed an estimated $156 billion in 2007, with projections to reach $315 billion by 2018 (Collins et al., 2009). With the time, costs, and personnel necessary to process billing and insurance-related (BIR) activities from contracting to payment validation on the provider side and the needs of payers to process claims and credential providers, significant redundancy and inefficiency arises from healthcare administration.


The recommendations don’t specifically mention that my service provider should not ask me if my insurance has changed three times or more for each visit, but it’s definitely consistent with the part about “significant redundancy.”

I don’t have the solution. I am just pointing out that the healthcare industry seems to be slower in fixing its inefficiencies than other industries. If you have the solution, let me know.

What are other opportunities for improvement in healthcare operations?


4 responses to “What healthcare can learn from aviation security

  • Michael Lugo

    I was actually asked those questions (electronically) while checking in for a flight this morning, on Turkish Airlines. I actually said to my wife “does anyone say that they didn’t pack their own bag? Clearly the answer you’re supposed to give is yes.”

  • prubin73

    What follows wouldn’t free up much in resources, but it might make the Red Cross look a bit less dopey. When I donate blood, I sign in with either a pseudo-credit card or, more recently, a smart phone app. I’m then asked to state my name. Okay, maybe it’s a stolen phone. Later on, during screening, I’m asked to state my name again. Typically it’s the same as it was the first time. Then, once they have me on the table and are getting ready to stick the needle in, they ask me again what my name is. (BTW, this is generally the same person asking me all three times.) Once I switched to “Ronald Reagan” on the third go-round; it didn’t seem to influence any of the decision making. (I’m thinking of trying “Dolly Parton” next time.)

    They also ask a few questions that are unlikely to change for most people. (I have to verify, at each visit, that I am to the best of my knowledge still male.) Perhaps this could be recorded in the database that the application uses, and the donor could be advised (and, no doubt, reminded periodically) that if their gender has changed, or if they have donated under another name since their last visit, they should go online and update their profile.

    Oh, one other thing comes to mind. Donors have to answer a slew of questions in a series of HTML forms. They are kind enough to provide an “I am male” button on a few pages (such as the one related to pregnancy issues) allowing me to skip the details. Of course, we establish that I’m male (to the best of my knowledge) before the quiz starts, so maybe the app could just skip those screens entirely?

  • DMHunter

    Well it seems the solution is staring you in the face. If you don’t like the billing and verification rituals of your current system then don’t use a system that requires it. I have used an HMO for over 30 years and rejoice in it’s simplicity and ease of use. And to be honest an HMO is much more willing to get you the care you need because they stop paying when you get healthy.
    Sooner or later the US will move to a single payer system and you will all learn what those of us using HMO’s have known for a long time that it really is much cheaper and much healthier if you don’t spend all that time and money on transaction costs.

  • Lambda Kansas City (@KCombinator)

    I’ve long held that part of the solution to the headache of healthcare is standardization of transactions. Bare minimums:

    * standardized timeline of bill submission and payment

    * requirements for accessibility of billing company and payee as far as dispute resolution (some insurance companies will ONLY communicate via USPS. Others make you wait on hold for an hour. Few take email/electronic comms in a useful fashion.).

    * Standardized coding for insurance companies, plans, and accounts. Some kind of required barcode on insurance cards, and insurance companies need to have instant online eligibility verification.

    * The concept of a “data broker”. The government-run auction site was a flawed idea from the beginning. Instead, you define the API for a marketplace and let those meeting certain standards participate. Let Amazon and Google duke it out with the insurance companies and hospitals for who can provide the best data availability and comms for patients and providers, and determine pricing. My idea is that I should, as a patient, be able to choose who houses my data and that access should be federated however I choose. Despite its name, the “Healthcare Information Portability and Accountability Act” (aka HIPAA) provides very little portability and even less accountability.

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