Craigslist, Telemedicine and Healthcare Startups

I have been planning to write about myZindgi for some time now. Since then Find my Doctor raised 20M. And TechJuice wrote about SehatYab. The theme is common i.e. all of them are trying to make healthcare more accessible by leveraging technology.

And though I share the ambition, I differ on strategy.

Before we get started I would like to acknowledge that myZindagi is doing a lot more than doctor discovery. They are doing telemedicine, their blog is surprisingly active, they got forums and they have a B2B thing going on which I am not completely aware of—there ain’t much information available. But the main thing is discovery. On that end, they are making the same mistake as the rest. And that’s not owning the customer relationship. Find my Doctor is totally focused on discovery. And SehatYab is experimenting with telemedicine. We will get to that later.

Craigslist for Doctors

I don’t think Airbnb is a good model to solve healthcare. But that can be a good start. The Craigslist or OLX model on the other hand is not even a good start. From a consumer perspective, healthcare remains very personal. Most people don’t think about it as another business-consumer relationship. Though I believe it favors everyone in the long run, the fact remains that society, in general, is not there as yet. Also, good doctors are expensive which makes it further difficult to trust a website that probably doesn’t know them very well. Perhaps, most importantly choosing a doctor is not something we do often. Or at least we try not to.

From a business perspective. First, the Craigslist model implies that you are not owning your customer. What does owning a customer mean? One, you need to be able to collect payments by yourself. Two, it means owning their problems. Problems like, what happens when the doctor does not honor the booking made through our website? Or what if we couldn’t make them agree to fee structure listed with us? It’s a bit trickier than giving a visitor someone’s phone number and be done with it. But that’s exactly what makes it worth doing. It also means staying small, at least in the beginning, and not getting distracted by metrics like MAUs, DAUs etc. If you want to own your customers, you better start with a small number. In the long run though having ten customers is much better than a thousand visitors.

Second, I don’t understand the business model if you don’t have customers. Either you are relying on ads, good luck with that. Or you will have to find a way to keep things rolling until you become Google or Facebook of healthcare. While that’s an ideal scenario, it’s unlikely to come true anytime soon. Speaking of Google and Facebook, both are very good resources for the information myZindagi or Find my Doctor is providing. To be clear Craigslist and OLX are still running. But their success was predicated by the pre-social era of the Internet.

Perhaps, most frustrating part is none of these startups are helping me connect to a doctor in a way not possible before. While the telephone operators in hospitals (at least the good ones) may not know anything about good customer service. They at least know their doctors better.

Telemedicine

While I am skeptical that Craigslist model will ever work, I think telemedicine can. The problem, however, is it’s an inferior product being offered to an over-served market. Private banks, hospitals, schools, no matter what you think of them. They are over-serving the urban population of Pakistan. So either you need a product that’s 10x better than what they are offering and charge a premium. Or you need to find customers that are being neglected by these incumbents i.e. people living in rural areas of Pakistan.

The later makes a lot of sense for these startups to consider. First, it solves the last mile problem of healthcare. Hospitals have no reach to the rural demographic. And presumably, they are not interested as well. Which makes these areas an ideal market for a startup to tackle. Second, by serving these under-served customers you can slowly build a product that catches up to what’s being offered by big-name hospitals. From Clay Christensen’s website (bold is mine):

Disruptive innovation, a term of art coined by Clayton Christensen, describes a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors.