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The US health care system is struggling with a mismatch between the large, simple (low-information) financial flow and the complex (high-information) treatment of individual patients. Efforts to implement cost controls and industrial efficiency that are appropriate for repetitive tasks but not high-complexity tasks lead to poor quality of care.
Multiscale complex systems analysis suggests that an important step toward relieving this structural problem is a separation of responsibility for 2 distinct types of tasks: medical care of individual patients and prevention/population health. These distinct tasks require qualitatively different organizational structures. The current use of care providers and organizations for both purposes leads to compromises in organizational process that adversely affect the ability of health care organizations to provide either individual or prevention/population services.
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A Report from Senator Sheldon Whitehouse for the U.S. Senate Committee on Health, Education, Labor & Pensions outline the underlying silent fact that this report is that the drivers of unnecessary and excess cost in the U.S. health care system result from systemic causes. Public insurance programs, private insurance coverage, military and veterans’ care, even corporate self-insurance, all are seeing dramatic and continuing cost increases. The problem is system-wide, and the solution must be too.
If these issues are not addressed, policymakers will face increasingly unpleasant and difficult threats to the insurance coverage, both private and public, of millions of Americans. Gail Wilensky, who oversaw Medicare and Medicaid under President George H.W. Bush, said, “If we don’t redesign what we are doing, we can’t just cut unit reimbursement and think we are somehow going to get a better system.”3 The ACA offers solutions that do not cut benefits or increase premiums, but instead reform systems of health care delivery to improve health outcomes and cost efficiency. The key challenge facing the United States is how quickly, thoroughly, and efficiently the reform of our health care delivery system can be implemented.
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