net neutrality

Net neutrality: As the US moves to gut the open internet, will other democratic countries follow?

The American internet industry is a powerful global force.

The internet may be an international system of interconnecting networks sharing a rough global consensus about the technical details of communicating through them, but each country manages its own internet environment independently. As the debate in the United States about the role of government in overseeing and regulating the internet continues, it is worth looking at how other countries handle the issue.

Our research and advocacy on internet regulation in the US and other countries offers us a unique historical and global perspective on the Federal Communications Commission’s December 2017 decision to deregulate the internet in the US. The principle of an open internet, often called “net neutrality”, is one of consumer protection. It is based on the idea that everyone – users and content providers alike – should be able to freely spread their own views, and consumers can choose what services to use and what content to consume. Network neutrality ensures that no one – not the government, nor corporations – is allowed to censor speech or interfere with content, services or applications.

As the US continues to debate whether to embrace internet freedom, the world is doing so already, with many countries imposing even stronger rules than the ones the FCC did away with.

US as trailblazer and laggard

Before 2015, many internet businesses in the US discriminated against or blocked customers from particular legal uses of the internet. In 2007, Comcast illegally blocked its customers from sharing files between themselves. In 2009, AT&T blocked access to Skype and FaceTime apps on its network. In 2011, MetroPCS blocked its customers from streaming Netflix and all other video streaming websites except YouTube, possibly due to a secretly negotiated deal. In 2012, Verizon disabled apps that let customers connect computers to their mobile data service. There were many other violations of the principle of net neutrality, too.

Customers and regulators tried to control these discriminatory practices over many years of public deliberation and multiple court cases. In 2015, under the Barack Obama administration, the FCC finalised the Open Internet Order, a set of rules barring internet service providers from speeding up or slowing down traffic based on its content or whether the companies posting it had paid extra to the company delivering the data. It was far from perfect – but nonetheless a giant leap forward.

In early 2017, after his inauguration, President Donald Trump appointed Ajit Pai, a former Verizon lawyer, as the FCC chairman. Pai, an Obama appointee to the FCC who had voted against the Open Internet Order in 2015, has moved rapidly to undo it. He and some other commentators believe that customers will get better service from a less-regulated market, ignoring that the rules only emerged in the wake of problems and consumer complaints.

Pai’s proposal has been criticised by former FCC chairman Tom Wheeler as “a shameful sham and sellout” to big telecommunications companies. A who’s-who list of the people who invented the technologies and systems underlying the internet denounced Pai’s policy as “based on a flawed and factually inaccurate understanding of internet technology”.

Other countries are facing similar dilemmas about how to deal with today’s digital realities, and are slowly and individually contributing to a patchwork of laws that differ from country to country. But many highly industrialised and rapidly developing countries share a general consensus that regulations ensuring an open internet are good for consumers and for civil society.

Opening the internet Brazilian-style

Brazil’s Civil Rights Framework for the Internet, enacted in 2014 and further refined in 2016, only allows internet service companies to prioritise certain types of traffic for technical reasons – such as overloaded networking capacity – or to allow network use by emergency services.

Yet, the country has been reluctant to enforce these rules and hold violators to account. Much like in the US, there is increasing concern that industry power has overwhelmed government regulatory agencies. Some of the largest telecom companies have been providing their mobile internet customers with preferential access to content on sites and services owned by business partners. Many Brazilian consumer rights groups are particularly alarmed because the companies receiving this privileged treatment are all large foreign corporations, including Facebook, WhatsApp, Twitter and music-streaming service Deezer, the only non-US company.

In addition, there are proposals in the works that would grant tens of millions of dollars in publicly owned telecom infrastructure to private companies for free. Brazilian internet freedom is further at risk because the country’s telecom companies are planning to insist that its regulators align with the weakened US rules.

Active enforcement in Europe

The European Union approved strong rules in 2015, requiring companies that provide internet access to handle all traffic equally, leaving flexibility to restrict traffic when network equipment was operating at its maximum capacity. EU rules also allow traffic restrictions to protect network security and handle emergency situations.

In 2016, the European Union’s electronic communications regulators detailed potential problems in agreements between telecom companies and content providers. They explained that quality of service could vary, but no specific applications should be discriminated against.

In 2017, they highlighted the importance of Europe’s emphasis on proactively monitoring compliance with net neutrality rules, rather than waiting for violations to happen before reacting. This gives European residents much stronger consumer protection than exists in the US.

India takes a stand

India has taken similarly strong steps. In 2016, the Telecom Regulatory Authority of India approved rules stating that “no service provider shall offer or charge discriminatory tariffs for data services on the basis of content”. In November 2017, the agency also issued “recommendations on net neutrality”, laying out rules of the road for internet service providers that incorporate substantial protections against content and application discrimination.

Indian regulators are looking to balance consumer and corporate priorities in areas such as security, privacy and ownership of data. Moreover, they are considering adopting regulations to spur competition in mobile data services.

Most importantly, Indian regulators make very clear that companies providing internet service should not do anything “that has the effect of discriminatory treatment based on content, sender or receiver, protocols or user equipment”. This puts openness at the core of internet service, the sort of clear consumer protection that public interest advocates and academics have called for.

The US is not an island

The US internet industry is a powerful global force, with billions of users all around the world. Further, the US government has traditionally been a leader in developing policies that balance free speech, consumer protection and other civil rights with strong opportunities for research and business innovation – but this too is now in decline.

Net neutrality protections might not be so necessary if the broadband market were more competitive. But 29% of Americans have no options for getting high-speed wired internet service at home. Another 47% have just one choice, and 20% have just two.

The telecom industry continues to consolidate, though the US Department of Justice is trying to block the pending AT&T-Time Warner merger. In this market with few providers, and many companies seeking profits by promoting their own content via their own networks, net neutrality protections will only become more important – not less so.

Lastly, legally speaking, policy and regulatory decisions made in the US do not hold any direct power in other countries. However, domestic rules about the internet will indeed affect the global conversation around net neutrality. What the US decides, through the FCC, the courts and potentially even through Congress, will determine whether US leadership on the internet remains strong, or whether it will cede ground to other countries willing to protect their citizens.

Sascha Meinrath is Director of X-Lab and Palmer Chair in Telecommunications, Pennsylvania State University. Nathalia Foditsch is a PhD student in Law and Communications, American University.

This article first appeared on The Conversation.

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What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

At the Emory University Hospital in Atlanta, visitors don’t have to worry about navigating their way across the complex hospital premises. All they need to do is download wayfinding tools from the installed digital signage onto their smartphone and get step by step directions. Other hospitals have digital signage in surgical waiting rooms that share surgery updates with the anxious families waiting outside, or offer general information to visitors in waiting rooms. Many others use digital registration tools to reduce check-in time or have Smart TVs in patient rooms that serve educational and anxiety alleviating content.

Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the marketing team and not by the editorial staff.