Abstract
Rising healthcare costs are major concerns in most high-income countries. Yet, political measures to reduce costs have so far remained futile and have damaged the best interests of patients and citizen. We therefore explored the possibilities to analyze healthcare systems as a socially constructed complex adaptive system (CAS) and found that by their very nature such CAS tend not to respond as expected to top-down interventions. As CAS have emergent behaviors, the focus on their drivers - purpose, economy and behavioral norms - requires particular attention. First, the importance of understanding the purpose of health care as improvement of health and its experience has been emphasized by two recent complementary re-definitions of health and disease. The economic models underpinning today's healthcare - profit maximization - have shifted the focus away from its main purpose. Second, although economic considerations are important, they must serve and not dominate the provision of healthcare delivery. Third, expected health professionals' behavioral norms - to first consider the health and wellbeing of patients - have been codified in the universally accepted Declaration of Geneva 2017. Considering these three aspects it becomes clear that complex adaptive healthcare systems need mindful top-down/bottom-up leadership that supports the nature of innovation for health care driven by local needs. The systemic focus on improving people's health will then result in significant cost reductions.
Highlights
In high income countries healthcare* costs were rising more rapidly during the past decennia than gross domestic products, and this generally is considered not to be sustainable[1]
There is a poor correlation between health care system structures and spending with patient health outcomes (Table 1)
Major efforts to lower healthcare expenditure by applying economic principles like fundholding, limiting services, capping or bundling payments, lean management, guidelines or pay-forperformance incentives have been tried in various jurisdictions; evaluations of these interventions on overall financial burden on society and/or patient/population health outcomes remain limited and unconvincing[1]
Summary
In high income countries healthcare* costs were rising more rapidly during the past decennia than gross domestic products, and this generally is considered not to be sustainable[1]. Alaskan native people realized a bottom-up customer owned system oriented toward physical, mental, emotional and spiritual wellness through community and interprofessional cooperation The change of their health system’s driver to embrace “shared responsibility, commitment to quality and family wellness” achieved a healthcare service that “” meets its patients’ and community’s needs and aspirations. Goals and values statements are the basis for a system’s driver that governs the behavior of complex adaptive organizations and ensures a level of dynamic stability. Though, financing of a complex adaptive healthcare organization should have no other purpose than to provide adequate resources to deliver needed health care services to its patients/communities. The health and wellbeing of my patient will be my first consideration.” Importantly, the declaration does not concern itself with the income of physicians, by implication may allude to a physician’s financial responsibilities in a later statement: “I will practice my profession with conscience and dignity and in accordance with good medical practice.” Of note, the Geneva Declaration expresses fidelity toward patients and the physician’s personal integrity while tacitly acknowledging economic and financial concerns
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