It was interesting that most in the room were technologists or healthcare policy people (or investors) but there were few physicians or hospital representatives.  Clearly all key parties must work together to improve access, quality and cost, just as they must in every healthcare system.  I sensed that this multi-disciplinary approach might not yet be typical of the Russian system–no surprise as no one is particularly good at aligning the incentives of everyone in a healthcare system.  It is a very disruptive thing to do and takes much time.  I was very struck, however, by a comment made by Dr. Peshkin, who said a key difference between the US and Russia is risk tolerance: Americans are very risk averse while Russians feel risk is a part of every day life.  He felt this would enable Russians to more quickly disrupt certain historical patterns in favor of new technology adoption.  I found this so curious as I would personally have thought just the opposite.  Americans are accustomed to blowing up whole industries in favor of new ways of doing business (witness Amazon, Google, Apple, etc) whereas my perception is that Russia moves quite slowly.  On the other hand, Moscow has built in 30 years a commercial culture that rivals New York or Paris in sophistication, breadth and advertising.  No doubt they can move quickly should they want to do so.

Health 2.0′s Pascal Lardier mentioned that he had done a quick survey of 50 Health 2.0 chapter leaders around the globe to elicit their view of the key drivers and obstacles around digital health innovation.  Drivers included:

    Presence of an entrepreneurial culture

    Need/demand for solutions

    Availability of early stage financing

    Strong supporting ecosystems

    Open health data

    Consumer demand/empowerment

Obstacles noted were:

    Stakeholder resistance due to impact on liability/compensation

    Reimbursement limitations

    Poor digital infrastructure

    Hostile environment for entrepreneurship (e.g., lack of funding, unfavorable IP laws, lack of human resources)

    Lack of financial incentives for innovation

All of these various topics were covered in the conference discussions in some form, including those around human discomfort with interacting with machines instead of doctors, appropriateness of consumers’ being trusted with certain healthcare tasks or information, and people’s willingness to change, even when they know change is right.  Marek Dziki, Executive Director of Skolkovo’s BioMed Cluster, captured the concept well when he said that, in his home country of Poland, instead of fixing a damaged road the authorities just reduce the speed limit. Healthcare systems in both countries clearly evidence some of this mentality.