As a bit of a surprise, I presently have two business plans on the board, instead of just one. A former student of mine asked me to mentor a business project he is starting up with his friend. The basic concept is that of an online platform for managing medical visits, and the innovation consists in using the Blockchain technology to create, for each patient using that functionality, a digital, trusted ledger of all their medical documentation, i.e. their medical visits, diagnoses, treatments received etc. all in one set of data, properly secured and available from any place on Earth.
Additionally, an educational project – a book on the FinTech industry accompanied by an educational toolkit – which I am running with a friend of mine, has gained in maturity and we will be giving it a definitive form. All in all, ideas and projects abound, and I decided to use my blog for conveying as accurate an account of my intellectual journey into all of these three realms. From now on, I am doing my best to weave an interesting story of scientific research out of three distinct stories, namely: a) my EneFinproject b) that medical ledger project, which I provisionally name MedUs, and c) the FinTech educationalpackage.
As for the EneFinproject, in my last update in French, namely in Les séquences, ça me pousse à poser cette sorte des questions, I came to the conclusion that the best way of starting with the EneFin concept is to create or to join an existing generalist trading platform, possibly using a cryptocurrency, such as Katipult, and include in its general features some options, which, in turn, are likely to spur the emergence of new suppliers in renewable energies.
A little pill of update for those who didn’t follow that update in French: I used a technique that data scientists frequently use, and which consists in expressing something we want as a sequence of events, actions and decisions. When I did this with the general concept, to be found in Traps and loopholes, I discovered that at least some potential users of the EneFinfunctionality are likely to have and want a bit more choice and freedom of movement in their financial decisions. I came to the (provisional) conclusion that the strictly spoken EneFinscheme, i.e. promoting the development of new suppliers in renewable energies, will sell better when expressed as a set of financial incentives, placed in the environment of an otherwise general, well-running platform of exchange, rather than as a closed system.
Right now, I am working through the issue of contracts and the legal rules that accompany them. I am deconstructing the typical contracts signed for the supply of energy, in order to have a very precise idea of what should the smart, crypto-coined contracts at EneFinlook like. Contracts are about securing a precise pattern of behaviour from the part of the other contracting party. I want to understand thoroughly the patterns of behaviour, those wanted as well as those unwanted ones, in the relation between a supplier of energy and his customers.
The business plan I am preparing form the MedUsconcept, I am at the phase of evaluating the size and the value of the market, together with defining, progressively, the core business process. Let me present a bit of the initial idea, and a few openings that it creates. The idea has its roots in the observation of the Polish healthcare market, which is a maze of mutually interweaving public funding and private schemes. An average Polish patient seldom can rely exclusively on the public provision of medical care. Frequent blood diagnostics, dental care, post-surgery rehabilitation – sooner or later, you just need to stop waiting for the public funding of these, and pay privately, either in the out-of-pocket formula, or in some kind of pooled funding scheme.
Those entangled, disparate funding patterns results in the dissipation of the patients’ medical records. The initial ides of MedUsis to take the already known functionality of online arrangement of medical appointments, and combine it with the aggregation and proper handling of digitalized medical records. You make an appointment with one doctor via MedUs, you are being diagnosed and treated, then you make an appointment with another doctor, another diagnosis and treatment ensue, and the record of all that is being stored with MedUs.
This is where the Blockchain technology becomes interesting. Blockchain is basically a ledger, and in handling medical records we need, precisely, a ledger. Medical records contain legally sensitive data, and improper handling can lead to a lot of legal trouble. Every single action taken regarding that data has to be properly documented, and secured against fraud. The basic digital architecture of medical records is that of a database, with the identity of the patient as the leading variable.
In those databases, well, s**t happens, let’s face it. I had a good example of that in my own recent experience. As some of you could have read in ‘The dashing drip of Ketonal, or my fundamental questions for the New Year’, due to a complicated chain of events, involving me, some herrings, and the New Year’s party, I spent the New Year’s night in an emergency ward of the district hospital, with the symptoms of acute food poisoning. As I was being released, on the New Year’s day, I had my official discharging documents. In those documents, space and time warped a little. It started with my data, and then I could read that I had been taken in charge three days earlier, in Berlin, with acute cardiac symptoms, and subsequently transferred to the very same hospital, and then, all of a sudden, my own (real) description followed.
As for me, I wouldn’t care, but my wife said: ‘Look, if you have any complications, or if you need any follow up in treatment, that official discharge will matter. Go to that hospital and make them get your records straight’. So I did, and you would really like to see the faces of people, in the hospital’s administration, when I showed them what I am coming with and for. It was that specific ‘Oh, f**k, not again!’ look. They got it straight, and so I stopped being that cardiac patient hospitalized in Berlin, but as far as I know, it all required a little bit of IT acrobatics.
As I described the situation to a friend of mine, an IT engineer, he explained me that this sort of things happen all the time. Our sensitive data is being stored in a lot of databases, and errors happen recurrently. Technically, once they happen, they should be bound to stay happened. Still, what do we have those IT engineers for? What you do, in such a case, is either to run ‘a minor reloading of the database, just to remove some holes in the security systems’, or you deliberately put the system to failure, and reboot it. Both manoeuvres allow miraculous disappearance of embarrassing data. A lot of institutions do it, like hospitals, banks, even ministries, apparently on a recurrent basis. This is, for example, the way that banks hush up the traces of hacking attacks on their customers’ accounts.
Databases with medical records are basically proprietary, i.e. each database has to have a moral entity clearly owning it and being responsible for it. That’s the law. If I use the services of many different medical providers, each of them runs their own database of medical records, and each such database is proprietary, which, in turn, means that my personal medical data is being owned by many entities in the same time. Each of these entities holds one piece of the puzzle, and the law prohibits any sharing between them, basically, unless a chain of official requests for information is being put in motion. As strange as it seems, such a request cannot be issued by the patient, whose medical records are in question. Only doctors can put my dispersed medical records into one whole, and I have no leverage upon that process.
Strange? Absurd? Well, yes, still no more than the promises, which some politicians make during elections. Anyway, that student of mine came up with the idea of using Blockchain to revolutionize the system. There is that digital platform, MedUs, which starts innocently, as a simple device to make appointments for private medical care. Now, revolution begins: each action taken by the patient, and about the patient, via MedUs, is considered as a transaction, to be stored in a ledger powered by the Blockchain technology. The system allows the patient to be effectively in charge of his own medical record, pertaining to all the medical visits, tests, diagnoses and treatments arranged via MedUs.
A sequence comes to my mind. A patient joins the MedUsplatform, and buys a certain number of tokens in its internal cryptocurrency. Let’s call them ‘Celz’. Each Celzcan buy medical services from providers who have joined MedUs. As it is a token of cryptocurrency, each Celzis being followed closely in all its visits and acquaintances: the medical history of the patient is being written in the hash codes of the Celzeshe or she is using in the MedUsplatform.
Crossbreeds, once they survive the crossbreeding process strictly spoken, are the strongest, the meanest, and the toughest players in the game of existence, and so I am crossbreeding my business concepts. The genes (memes?) of EneFingently make their way inside MedUs, and the latter sends small parcels of its intellectual substance into EneFin. Yes, I know, the process of crossbreeding could be a shade more fun, but I am running a respectable scientific blog here. Anyway, strange, cross-bred ideas are burgeoning in my mind. Each subscriber of the EneFinplatform could have all the history of their transactions written into the hash codes of the cryptocurrency used there, and thus the EneFinutility could become something like a CRM system (Customer Relationship Management), where each token held is informative about the past transactions it changed hands in. How would the reading of such data, out of the hash code, work in the (legal) light of General Data Protection Regulation (GDPR)?
On the other hand, why couldn’t patients, who join the MedUsplatform, use their Celzesto buy participation in the balance sheet of those medical providers who wish such a complex deal? Celzes used to buy equity in medical providers could generate extra purchasing power – more Celzes – to pay for medical services.
In both projects, which I am currently preparing business plans for, namely in EneFin, and in MedUs, the Blockchain technology comes as a simplifying solution, for transforming complex sets of transactions, functionally interconnected, into a smooth flow of financial deeds. When I find a common denominator, I tend to look for common patterns. I am asking myself, what do these two ideas have in common. What jumps to my eye is that both pertain to that special zone of social interactions, when an otherwise infrastructural sector of the social system gently turns into something more incidental and mercantile. It is about giving some spin to those portions of the essential energy and healthcare systems, which can tolerate, or even welcome, some movement and liquidity, without compromising social stability.
As I see that similarity, my mind wanders towards that third project I am working on, the book about FinTech. One of the essential questions I have been turning and returning in my head spells: ‘What is FinTech, at the bottom line? What part of FinTech is just digital technology, versus financial innovation in general?’. Those fundamental questions popped in my head some time ago, after some apparently unconnected readings: the Fernand Braudel’s masterpiece book: ‘Civilisation and Capitalism’, ‘The Expression of The Emotions in Man and Animals’ by Charles Darwin, and finally ‘Traité de la circulation et du crédit’ by Isaac da Pinto. It all pushed me towards perceiving financial deeds, and especially money, as some kind of hormones, i.e. systemic conveyors of information about what is currently the best opportunity to jump on.
A hormone is information in solid form, basically, just obtrusive enough to provoke into action, and light enough to be conveyed a long way from the gland it originates from. OK, here I come: gently and quietly, I have drifted towards thinking about the nature and origins of money. Apparently, you cannot be a serious social thinker if you don’t think about it. Mind you, if you just think about the local (i.e. your own) lack of money, you are but a loser. It is only when you ascend beyond your own, personal balance sheet that you become a respectable economist. Karmic economics, sort of.
Being a respectable social thinker does not preclude practical thinking, I hope, and so I am drifting back to business planning, and to the MedUsconcept. My idea is that whatever will be the final span of customers with that online platform, it is going to start in the market of private healthcare, or, as I think about it, peri-healthcare as well (beauty clinics, spa centres, detox facilities etc.). Whatever the exact transactional concept will be finally developed, any payment made by the customers of MedUswill be one of these: a) a margin, paid by the patient over the strictly spoken price of the healthcare purchased b) a margin, paid by the provider of healthcare out of the price they receive from the patient, or, finally, c) a capital expense of the healthcare provider, to be reflected in some assets in their balance sheet. Hence, I need to evaluate the aggregate value of payments made by patients, the distribution of the corresponding expenditure per capita, and the capital investments in the sector. Studying a few cases of healthcare businesses, just to get the hang of their strategies, would do no harm either.
As I browsed through the website of the World Health Organization, I selected 17 indicators which seem relevant to studying the market for MedUs. I list them in Table 1, below. They are given either as straight aggregates (indicators #11 – 17), as per capita coefficients, or as shares in the GDP. When something is per capita, I need to find out about the number of capita, for example with the World Bankand from then on, it is easy: I multiply that thing per capita by the amount of capita in the given country, and I fall on the aggregate. When, on the other hand, I have data in percentages of the GDP, I need the GDP in absolute numbers, and the World Economic Outlook database, by the International Monetary Fund, comes handy in such instances. Once again, simple multiplication follows: % of GDP times GDP equals aggregate.
Table 1 – Selected indicators about national healthcare systems, as provided by the World Health Organization
|Indicator #1||Current Health Expenditure (CHE) as % Gross Domestic Product (GDP)|
|Indicator #2||Health Capital Expenditure (HK) % Gross Domestic Product (GDP)|
|Indicator #3||Current Health Expenditure (CHE) per Capita in US$|
|Indicator #4||Domestic Private Health Expenditure (PVT-D) as % Current Health Expenditure (CHE)|
|Indicator #5||Domestic Private Health Expenditure (PVT-D) per Capita in US$|
|Indicator #6||Voluntary Financing Arrangements (VFA) as % of Current Health Expenditure (CHE)|
|Indicator #7||Voluntary Health Insurance (VHI) as % of Current Health Expenditure (CHE)|
|Indicator #8||Out-of-pocket (OOPS) as % of Current Health Expenditure (CHE)|
|Indicator #9||Voluntary Financing Arrangements (VFA) per Capita in US$|
|Indicator #10||Out-of-Pocket Expenditure (OOPS) per Capita in US$|
|Indicator #11||Voluntary prepayment, in million current US$|
|Indicator #12||Other domestic revenues n.e.c., in million current US$|
|Indicator #13||Voluntary health insurance schemes, in million current US$|
|Indicator #14||NPISH financing schemes (including development agencies), in million current US$|
|Indicator #15||Enterprise financing schemes, in million current US$|
|Indicator #16||Household out-of-pocket payment, in million current US$|
|Indicator #17||Capital health expenditure, in million current US$|
I am wrapping up writing, for today. I am consistently delivering good, almost new science to my readers, and love doing it, and I am working on crowdfunding this activity of mine. As we talk business plans, I remind you that you can download, from the library of my blog, the business plan I prepared for my semi-scientific project Befund (and you can access the French versionas well). You can also get a free e-copy of my book ‘Capitalism and Political Power’ You can support my research by donating directly, any amount you consider appropriate, to my PayPal account. You can also consider going to my Patreon pageand become my patron. If you decide so, I will be grateful for suggesting me two things that Patreon suggests me to suggest you. Firstly, what kind of reward would you expect in exchange of supporting me? Secondly, what kind of phases would you like to see in the development of my research, and of the corresponding educational tools?