• 08.15.16

Why Is Health Care Design So Terrible?

Health care consumers pay a lot of money for bad design. It’s time for the device and drug companies to stop.

Why Is Health Care Design So Terrible?

A regular glass ketchup bottle is a poorly designed experience. To serve the ketchup you have to hold it at a 45-degree angle, tap it in a special place, insert a knife, and then it splatters not only onto your plate but also onto your lap.


Lo and behold the improved design of the squeezable plastic upside down ketchup bottle; the ketchup is right at the opening, it has a valve that doesn’t leak, and it comes out of the bottle faster. Heinz designed a better ketchup experience, resulting in a product that is easier to use. That in turn has led to product design awards and greater sales.

The unfortunate reality is that this kind of experience design doesn’t often occur in health care. Instead, this is what happens:

The condiment on the left costs $2.50; the one on the right costs $250.

No innovation in product or experience design, just higher prices.

The EpiPen is a prime example of this.

As a food allergy mom, I’ve written about the bad design of the EpiPen injection delivery system. To give the injection, you must pull off the blue cap, but the needle pops out at the opposite end, which is counterintuitive. Users will inadvertently place their fingers over the needle, leading to thousands of unintentional injections of individuals trying to deliver the medication. The EpiPen is so badly designed that it’s used as a case study of bad medical device design by human factors design professionals.

Unfortunately because of recalls of other allergy medications, there are no other competitor products. As described in an article from STAT, Mylan, the company that manufactures the medication, has increased prices dramatically. Whereas it used to cost about $100 for two EpiPens, the price has increased to $600 or even $900.

The life-saving medicine on the left costs $100; the one on the right costs $600.

Pharmaceutical companies usually justify their price hikes based on the fact that they are funding not only the cost of medication but also research and development. However, Mylan bought the rights to the medication in 2007, and hasn’t made any substantive changes to the design of the device. Given the lack of competitor products, this has prompted comparisons of the company to Martin Shkreli and Valeant Pharmaceuticals.

The prices are having an impact on patients and families, who can’t afford the medication and are forced to carry around expired pens or take a huge risk and go without the medication. Sadly, emergency medical technicians in Washington State can’t even afford to carry standard EpiPens, so they have created their own do-it-yourself epinephrine injection kit. It consists of a vial of epinephrine ($4), and needles ($1). (Yes incredibly, you can buy ampules of epinephrine at a fraction of the cost of an EpiPen, which means that we are paying $600 for a hunk of badly designed plastic.)

The irony is that the DIY solution may be the better designed solution. The cap is at the same end as the needle on a regular syringe, so the inadvertent injection is less likely to happen. In addition, use of the kits has led to more extensive EMT training in management of allergic reactions–EMTs were often reluctant to use the medication if symptoms weren’t severe–and has led to an increase in the appropriate use of injections, from 40% to over 98%.

As Kate Farnsworth describes:

Perhaps food allergy patients and caregivers will have to follow the do-it-yourself model of Nightscout, a DIY mobile technology system for diabetes that was created by patients and caregivers. The community helps individuals create their own DIY medical devices in a variety of ways, such as providing open-source code and instructions online, virtual support through a Facebook group, and in-person support through DIY “build” parties.

Are “build parties” for DIY epinephrine kits on the horizon for the allergy community? Outlandish prices and the sad lack of innovation are a major #healthcare #design #fail. It is happening not only with EpiPens but also with insulin, Narcan, and a variety of other pharmaceuticals.


We pay lots of money for bad design in health care. When will device and drug companies create user-centered innovations that actually improve the lives of patients instead of their bottom line?

The article was adapted with the author’s permission. Read the original here.

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About the author

Joyce Lee MD, MPH, is the Robert P. Kelch MD Professor of Pediatrics at the University of Michigan Medical School and is a physician, designer, and researcher.