Health care costs can be reined in and quality can be improved by separating population-based and preventive care from individual care of ill patients, reports a new article in the American Journal of Public Health. Care providers can make immunizations, screening and some forms of routine treatment much more efficient and cost-effective without sacrificing quality, and doing so would give doctors more time and resources to devote to complex individualized care.
According to the article, the current top-down cost control measures imposed by insurers are ineffective and even harmful. The policies made by insurers influence how doctors can treat their patients, and often have unforeseen negative impact on the quality of care. Decisions made by physicians should be based upon medical needs. However, the way doctors are paid affects how they work, how much time and attention they give to patients, and ultimately what decisions they make.
The author of the article, Professor Yaneer Bar-Yam notes that, ironically, in many parts of the country efforts to cut costs by the insurers often lead to a vicious cycle, where the first services to be cut are preventive care programs. While this saves money in the short term, the elimination of these programs ultimately has a detrimental impact on overall health and raises costs in the long term. Because this has been going on for some time, today we are paying dearly for cuts in prevention that were made years ago.
What we need, according to Bar-Yam, is to separate the complex tasks of individualized medical care from the large-scale, simple repetitive tasks of preventive and population-based care such as immunizations and screening tests. This frees up doctors to provide the best possible care for individual patients, while insurers can use top-down methods to make simple preventive measures as efficient as possible. “The overall system can be dramatically improved,” Bar-Yam concludes, “by establishing two separate but linked systems with distinct forms and organizational objectives, one to deal efficiently with the large scale, repetitive, population based care, and the other to address effectively the complex tasks of attending to the needs of medically ill patients."
There are much more general insights in the article that apply more broadly. "In order for an organization to be effective," Bar-Yam writes "there must be a match between the functional capabilities of organization and the complexity of the task to be performed."
The article Improving the Effectiveness of Health Care and Public Health: A Multiscale Complex Systems Analysis by Yaneer Bar-Yam appears in the March 1 issue of the American Journal of Public Health. Click here to download the full text.
The New England Complex Systems Institute (NECSI) has been instrumental in the development of complex systems science and its applications for the past ten years. NECSI promotes the study of complex systems for the betterment of society via research and education. As President of NECSI, Professor Bar-Yam has been applying complex systems science to fields including health care, globalization, networks, biology, engineering and social sciences.