Acerca de sectores estáveis e demasiado homogéneos na oferta (parte IV)

Parte I e parte II e parte III.
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Em Junho de 2012 critiquei e classifiquei como errada a opinião do futuro presidente da república em "Agora é que vão começar as decisões políticas".
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Quando há dinheiro, quando há recursos, verdadeiramente não é preciso estratégia. Contudo, quando faltam os recursos, é preciso fazer escolhas, é preciso renunciar... é preciso ter uma estratégia, ter uma política.
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A nossa política passa por:

"baixar impostos, aumentar salários, reduzir importações, aumentar emprego, fazer obras, redistribuir pelos mais fragilizados, acabar com a austeridade, aumentar o défice e reduzir a dívida"

Estão a ver o resultado do teste de Roger Martin?
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Pois!
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Agora, voltemos ao mercado interno e ao sector da saúde. Consideremos este texto "Why Strategy Matters Now" de Michael Porter e Thomas Lee, publicado pelo "The New England Journal of Medicine.

"Until recently, most health care organizations could get by without a real strategy, as most businesses understand that term. They didn’t need to worry about how to be different or make painful decisions about what not to do. [Moi ici: Are you there Mr Rio?] As long as patients came in the door, they did fine, since fee-for-service contracts covered their costs and a little more. Success came from operational effectiveness: working hard, embracing best practices, and burnishing reputations that attracted both patients and talent. Virtually every provider was included in most payers’ networks, and patients could generally seek care wherever they pleased at modest or no extra cost. Most organizations maximized revenue by offering every possible service in volumes as large as possible and expanding the same well-reimbursed services to cross-subsidize less profitable ones. Typically, “strategy” defaulted to having the scale and market presence to secure good rates and be included in networks.
But that era is ending.[Moi ici: Nas estruturas de saúde do Estado ainda estamos na fase dos hospitais-cidade, organizações demasiado complexas para funcionarem, e dos hospitais separados entre si por 30 km e que competem entre si pelas especialidades todas]
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Many health care organizations today are running near full capacity but have flat or declining revenues. Bargaining power has shifted away from providers.
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The time has come for health care organizations to rethink the meaning of strategy. Strategy is about making the choices necessary to distinguish an organization in meeting customers’ needs.
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In the new era, strategy must reflect a health care organization’s fundamental purpose: what it is trying to achieve and for whom. Financial margins and growth targets will be the results rather than the drivers of strategy. Historically, organizations could pursue multiple goals, such as meeting all their communities’ health care needs, preserving physicians’ autonomy, educating clinicians, and conducting research. Today, one goal must become paramount: improving value for patients.
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IPUs need to differentiate themselves from competitors by emphasizing care for certain types of patients — those for whom they can achieve better outcomes and have particular expertise, or those for whom they have similar outcomes as competitors but can deliver care at a lower cost, more quickly, or more conveniently."

Para onde quer que olhemos, sempre o mesmo padrão. Ainda darei maus um exemplo na parte V.