Improving the effectiveness of health care and public health: a multiscale complex systems analysis.

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. Thus, the overall system can be dramatically improved by establishing 2 separate but linked systems with distinct organizational forms: (a) a high-efficiency system performing large-scale repetitive tasks such as screening tests, inoculations, and generic health care, and (b) a high-complexity system treating complex medical problems of individual patients.

[1]  Vandana Sundaram,et al.  The American Journal of Public Health. , 1945, American journal of public health and the nation's health.

[2]  C. E. SHANNON,et al.  A mathematical theory of communication , 1948, MOCO.

[3]  Charles F. Hockett,et al.  A mathematical theory of communication , 1948, MOCO.

[4]  K. Weick.  The social psychology of organizing , 1969 .

[5]  George A. Akerlof,et al.  The Market for `Lemons , 1970 .

[6]  Jay R. Galbraith.  Designing Complex Organizations , 1973 .

[7]  Joseph E. Stiglitz,et al.  Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information , 1976 .

[8]  N. R. E. Fendall,et al.  DECLARATION OF ALMA-ATA , 1978, The Lancet.

[9]  Henry Mintzberg,et al.  The Structuring of Organizations , 1979 .

[10]  K. Weick,et al.  The Social Psychology of Organizing, 2d ed. , 1980 .

[11]  J. Banta,et al.  World Health Forum an international journal of health development, published quarterly by the World Health Organization, Geneva, Switzerland. Price per copy Sf 10; for 1981 volume Sf 30 , 1981 .

[12]  Richard L. Daft,et al.  Organization Theory and Design , 1983 .

[13]  R C Coile,et al.  The future of public health. , 1990, Hospital strategy report.

[14]  Thomas M. Cover,et al.  Elements of Information Theory , 2005 .

[15]  S. Horn,et al.  Intended and Unintended Consequences of HMO Cost-Containment Strategies: Results from the Managed Care Outcomes Project , 1996 .

[16]  Yaneer Bar-Yam,et al.  Dynamics Of Complex Systems , 2019 .

[17]  Feng Li,et al.  Mass screening for lung cancer with mobile spiral computed tomography scanner , 1998, The Lancet.

[18]  S. Horn,et al.  Formulary limitations and the elderly: results from the Managed Care Outcomes Project. , 1998, The American journal of managed care.

[19]  J. Bland,et al.  Protecting the world's children: the story of WHO's immunization programme. , 1998, World health forum.

[20]  R. Ellis,et al.  Creaming, skimping and dumping: provider competition on the intensive and extensive margins. , 1998, Journal of health economics.

[21]  R. Sharma,et al.  Health-Care Payment Systems: Cost and Quality Incentives—Comment , 1998 .

[22]  C. Ma,et al.  Health-Care Payment Systems: Cost and Quality Incentives—Reply , 1998 .

[23]  Thomas G. McGuire,et al.  Optimal Risk Adjustment in Markets with Adverse Selection: An Application to Managed Care , 2000 .

[24]  E. Keeler,et al.  Do longer postpartum stays reduce newborn readmissions? Analysis using instrumental variables. , 2000, Health services research.

[25]  J. Goode,et al.  Implementation of a pharmacy-based immunization program in a supermarket chain. , 2000, Journal of the American Pharmaceutical Association.

[26]  Julio Frenk,et al.  World Health Report 2000: a step towards evidence-based health policy , 2001, The Lancet.

[27]  D. Altman,et al.  The sad history of health care cost containment as told in one chart. , 2002, Health affairs.

[28]  MA CHING-TOALBERT.  Health-Care Payment Systems: Cost and Quality Incentives - Reply , 2003 .

[29]  Yaneer Bar-Yam,et al.  Multiscale variety in complex systems , 2004, Complex..

[30]  Y. Bar-Yam.  Making Things Work: Solving Complex Problems in a Complex World , 2004 .

[31]  Declaration of Alma-Ata International Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978 , 2004 .

[32]  Yaneer Bar-Yam.  Multiscale variety in complex systems: Research Articles , 2004 .

[33]  K. Arrow.  Uncertainty and the welfare economics of medical care. 1963. , 2004, Bulletin of the World Health Organization.

[34]  L. Curry.  The Future of the Public's Health in the 21st Century , 2005 .

[35]  P. Dasgupta,et al.  Equilibrium in Competitive Insurance Markets : An Essay on the Economics of Imperfect Information , 2007 .

[36]  T. Watson,et al.  Organization Theory and HRM , 2008 .