# ZOM : Digital Accessibility and Accountability for Healthcare `Sanjé Witter` ``sanje.witter@yazom.com`` `zom.health`   ## Abstract A healthcare ecosystem that provides ease of accessibility and accountability is essential for improved life-expectancy and human development. It would increase the probability of affordability, reduce expenditure and prompt providers to offer the highest quality service. These results would be the by-product of factors emphasized by Porter’s Five Forces Model through near perfect competition. For this to become a reality, legacy systems and even worse, paper-based systems will need replacement. An unhackneyed ecosystem that is low in totalitarianism, neutral on minarchism with a tint of decentralization could prove optimal. This model would allow for ease in verification of healthcare services whilst also lowering barriers to entry and in doing so provide a gamut of opportunities/alternatives.   ## Introduction Healthcare services have largely been legacy-systems and paper-based infrastructure. These systems served as the entirety of interaction within an industry where premium costs do not necessarily translate to premium services. The siloed architecture has led to numerous sub-optimal services and treatment that has resulted in a reduction of life quality and expectancy. To improve healthcare services, an ecosystem that provides equitable offerings is required. By virtue of executing sufficiently on this method not only will healthcare be more affordable for the general population but the service received will be of greater quality. A case could be made that this would remove the stigma of ageism and illness that perpetuates the sector. In theory, the utilization of healthcare services would shift on its axis from rarely to occasionally and in some instances frequently. This would not be the result of any detrimental causes but rather the understanding in the prevention of them. The ideal ecosystem requires accessibility through the use of on-demand availability of computer system resources, especially data storage and computing power, without direct active management. In addition to accessibility, accountability needs to operate in tandem and as such a modification-resistant ledger that host activities at the minimal level is a necessity in maintaining the integrity of events that cater to transparency/privacy trade-offs.   ## Accessibility The definition of accessibility as it relates to healthcare can be categorized in two distinct notions: affordability and availability. ### Affordability Affordability is concerned with the expenditure required to acquire the necessary service. In the presence of healthcare, affordability can be achieved through some approximation of perfect competition (Machovec, 1995) . Perfect competition provides both allocative efficiency and productive efficiency: * Such markets are allocatively efficient, as output will always occur where marginal cost is equal to average revenue i.e. price (MC = AR). In perfect competition, any profit-maximizing producer faces a market price equal to its marginal cost (P = MC). This implies that a factor's price equals the factor's marginal revenue product. It allows for derivation of the supply curve on which the neoclassical approach is based. * In the short-run, perfectly competitive markets are not necessarily productively efficient, as output will not always occur where marginal cost is equal to average cost (MC = AC). However, in the long-run, productive efficiency occurs as new firms enter the industry. Competition reduces price and cost to the minimum of the long run average costs. At this point, price equals both the marginal cost and the average total cost for each good (P = MC = AC). :::info **Figure 1:** Perfect Competition   ![image alt](https://i.imgur.com/aEymcGA.jpg "title" =700x) ::: In order to achieve an approximation of perfect competition a matrix of insurance, customers, healthcare providers and service offerings need to be established. Such that insurance and customers are complementary with benefits resulting from service offerings and healthcare providers. The segment of the matrix concerned with affordability is insurance; this allows for customers to explore all other avenues of the matrix such as which healthcare providers and service offerings are suitable. A school of thought that can be explored is decentralized financing (Financial derivatives and Stable-Value Currencies, 2020) where participants can partake in an asset class by using funds as collateral on which to gain more of the desired asset to use for health coverage. In a standard insurance policy, you are not credited with the original amount used as collateral if no event triggers its use. This is an expense that is arguably greater than impermanent loss. In any instance healthcare decentralized financing can be complementary to standard and travel insurance policy or stand on its own. In the presence of the former, you’d be capitalizing on funding the necessary costs. In the case of the latter, you can supply the cost for the coverage and then make a claim upon your return where applicable. In the absence of either or both, this acts as a form of limited insurance but the benefit of quality service remains. :::info **Figure 2:** Decentralized Financing Method   ![image alt](https://i.imgur.com/9ZEWDCO.png "title" =700x)[]() ::: ### Availability Generally, speaking there is a dearth of skilled healthcare workers in emerging economies and third world countries (International Labour Organization, 2020). This situation is a combination of both expense and unemployment. The former is offset by the fact that most people can’t afford healthcare so there is no need for a larger skilled healthcare employee set which results in a cause and effect on the latter; unemployment (International Labour Organization, 2019). Given the understanding of the model mentioned in ‘affordability’ above, one can posit that with greater affordability there will be more opportunities. This goes back to the original position - near perfect competition. This model can’t rely totally on decentralized financing as it is one part of the whole. A complementary implementation of a system where anyone can access health services efficiently and reliably is a vital requirement. This translates to on-demand availability of resources, data storage and computing power supported by mobility. This would in effect create opportunities using two sectors of Porter’s Five Forces Model : New Entrants and Substitutes (Porter, 2008). Note that substitute does not mean a reduction in the quality of service but rather a reduction of cost amongst competitors resulting in a substitute for a suitable alternative which in healthcare can be used to define “ your family doctor” and “frequently visited pharmacy”. :::info **Figure 3:** Porter’s Five Forces Model   ![image alt](https://i.imgur.com/DA188MX.gif "title" =700x)[]() :::   ## Accountability ### Transactions The verification of payment made for services solicited is paramount. This means that all parties involved should arrive at a consensus before total participation within the ecosystem. Importantly, this system requires immutability and transparency. This means utilizing a ledger that is immutable, supports state transition and applications simultaneously (Ethereum State Transition Function, 2020). This means that any payment made for services rendered should be verifiable and without tamper. In such an instance, healthcare providers and their clients have maximum incentive to be trusted participants or sanctions/penalties could be levied resulting from supporting evidence brought forth during a judicial hearing. ### Identification For any systematic model to thrive, it requires habit forming by its participants. In order for these habits to form, repetition is required but more importantly an understandable design. This means that any implementation has to be understandable and have user friendly attributes both at the experience and design level. We can think of this identification system not as a trade-off on privacy but as an extension to x-byte address. This should be some instance of the naming feature (Kalodner, 2015). In doing so, reliance on the incommodious property of addresses are secondary for technical reconciliation. ### Reputation Reputation systems offer a medium where users can quantify the trustworthiness or reliability of individuals providing online services or products. In the healthcare industry data integrity is fundamental. In an ecosystem where transactions are the backbone for verification. A method can be constructed around how healthcare providers are able to make adjustments to data even if all information is not stored on the ledger. This process involves transaction fees before access is given to make adjustments. The approach is part central and decentral, this balance has the attributes of reliability and efficiency. In this set-up, any changes made after the fact must be placed on the ledger. The fees involved are nominal and are attractive for authentic adjustments but in turn at an opportunity cost for dubious participants as demonstrated by the Hidden Markov Model (Zucchini et al., 2016) . :::info **Figure 4:** Hidden Markov Model - Relationship States & Migration Paths   ![image alt](https://i.imgur.com/nRxdoGU.png "title" =700x) :::   ## Conclusion Healthcare is a siloed and stigmatized industry. This needs to be resolved as it is a component of the base of maslow’s hierarchy of needs (Maslow, 2013) and highlights the most basic element of quality of life. You can compromise on the quality of food, clothing, education, entertainment but not healthcare. The ecosystem proposed is a commitment to resolving the main pain points of the healthcare system: accessibility and accountability. There is no need to do anything without checks and balances. All participants will rely on on-demand availability of computer system resources data storage and computing power in tandem with modification-resistant ledger. This means, in use-case terms: 1. You select a healthcare provider 2. Visit the selected healthcare provider 3. Conduct transactional service with the healthcare provider 4. Activities logged 5. Claim, if required from third party or judicial hearing if necessary. The aim is quite clear, ecosystem optimization and image reconstruction. Healthcare should not be seen as a last resort because of expense or stigma. It should be treated as routine without financial constraints.   ## References Ethereum Foundation (2020). *Financial Derivatives and Stable Currencies.* Ethereum. https://ethereum.org/en/whitepaper/#financial-derivatives-and-stable-value-currencies Ethereum Foundation (2020). *Ethereum State Transition Function.* Ethereum. https://ethereum.org/en/whitepaper/#ethereum-state-transition-function International Labour Organization (2019). *More than half the global population lacks health care and social security.* Ilo. https://ilostat.ilo.org/covid-19-are-there-enough-health-workers/ International Labour Organization (2020). *COVID-19: Are there enough health workers?.* Ilostat. https://ilostat.ilo.org/covid-19-are-there-enough-health-workers/ Kalodner, Harry (2015). *An empirical study of Namecoin and lessons for decentralized namespace design.* Princeton University. https://www.econinfosec.org/archive/weis2015/papers/WEIS_2015_kalodner.pdf Machovec, Frank (1995). *Perfect Competition and the Transformation of Economics (Routledge Foundations of the Market Economy).* Routledge. Maslow, Abraham H. (2013). *A Theory of Human Motivation.* Martino Fine Books. Palmatier, Robert & Sridhar, Shrihari (2017). *Marketing Strategy: Based on First Principles and Data Analytics.* Springer. Porter, Michael E. (2008). *On Competition.* Harvard Business Press Review. Zucchini, Walter, MacDonald Iain L., & Langrock, Roland (2016). *Hidden Markov Models for Time Series: An Introduction Using R.* Chapman and Hall/CRC.   ## Appendix Organic growth is imperative for any product/service to thrive. In fact, the pareto principle applies to most economic circumstances particularly ones influencing growth. A model that provides an incentive for customers through a designated offering could improve the customer’s lifetime value (Palmatier & Sridhar, 2017). A designated offering could potentially increase the chances for a successful product with a large market share and an industry shift. The speculative feature of this asset should be secondary to its primary purpose.   $$ CLVx = {Mx - Cx\over 1 - rx + d} - Ax $$   | Key | | | ----------------- |----------------------- | | $$CLVₓ$$ | Customer Lifetime Value | | $$Mₓ$$ | Margin of ith customer in $ | | $$Cₓ$$ | Annual marketing cost for ith customer in $ | | $$rₓ$$ | Retention rate for ith customer as a % | | $$dₓ$$ | Discount rate as a % | | $$Aₓ$$ | Acquisition cost for ith customer in $ |