Is U.S. health care an appropriate system? A strategic perspective from systems science

Source: Ivo P. Janecka, Health Research Policy and Systems, Vol. 7 no. 1, 2009

U.S. health care is commonly referred to as a system that consumes an ever-increasing percentage of the gross domestic product while delivering seemingly diminishing value (seen as a relationship among quality, risk, and cost) and continuously eluding remedies. Such observations point to chronic fundamental systemic organizational misalignments. The purpose of this study was to examine the degree of compliance of U.S. health care with systems science principles, which approximate the framework of successful organizational settings found in biology; if followed, these guidelines should optimize societal health care.

The current state of health care represents a structural and functional outcome of its historic contradictions with systems science principles, that is, a mismatch of vertical (those that represent government legislature) and horizontal (patients with providers involved in health care) hierarchies and the failure of components relationships, all resulting in substantial damage to the overall system’s self-organizing capacity. In view of the changing dominant economic and political cycles, health care is visibly failing and showing signs and symptoms that indicate that its survival is at risk (e.g., diminishing value, runaway cost, breakdown of relationships, demoralized providers, etc.). A search for an alternate perspective leading to a comprehensive solution seems paramount. Einstein’s comment that “no problem can be solved from the same consciousness that created it” encourages this approach.

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