Most innovation in health care occurs at the high end: better – and more expensive – drugs, technology, procedures and medical settings driven by the promise of higher revenues and profits.

It’s a money pipeline. Consumers usually don’t pay the bill themselves, public and private payers are accustomed to paying for procedures deemed necessary and appropriate by physicians, the general public is fascinated with gee whiz technology, and there is precious little transparency of costs and benefits between buyers and sellers.

Innovations at the low end – retail clinics staffed by mid-level clinicians, inexpensive home diagnostic devices, knowledge and online self-help networks organized by and for patients with specific diseases – are generally resisted by the medical establishment, which depends on ever higher revenue streams to feed a high-tech and labor-intensive infrastructure. There is little incentive for a physician to recommend that a patient buy a non-prescription, reliable, easy-to-use cholesterol test kit for $10 when they can come to her office and pay up to ten times that amount for the same result.

Innovation will occur, regardless. Read more in this month’s The Drift.