Roger D. Jones PhD
Center for Complex Systems and Enterprises
Stevens Institute of Technology
Originally written December 10, 2013
Condensed from a presentation to the Center for Complex Systems and Enterprises at the Stevens Institute of Technology on November 12, 2013
Healthcare is so complicated
Healthcare in the U.S. is complicated. There are dozens of components: hospitals, hospices, assisted living facilities, nursing homes, home care, pharmacies, pharmaceutical companies, the Food and Drug Administration, the Patent Office, specialized physicians, general physicians, physicians assistants, nurses, medical device manufacturers, Medicare, Medicaid, private insurers, self insurers, employers, self-employed, wellness centers, chronic conditions, acute conditions, end-of-life conditions, rare diseases, personalized medicine, cosmetic surgery, concierge medicine, and many more. The complication is impossible for any single person to penetrate or understand.
Why is healthcare so complicated? The field is impenetrable because human bodies are complicated. In the early twentieth century bodies were simpler. At that time, people tended to die from acute conditions before their health became Gordian from chronic conditions. Medicine was simpler. It consisted almost solely of providing comfort to those at the end of their lives. Medicine has added years to our life expectancies with the consequent increase in healthcare complication. The higher population densities of today have also added complexity by providing rich biological cultures for infectious diseases. Moreover, personalized medicine is making life bewildering. Sequencing an individual genome is now inexpensive enough for every person to be able to identify his or her own disease susceptibility spectrum, which must be understood and managed individually.
How do we make enough sense out of healthcare so that the system can be managed efficiently and effectively? It is absolutely true that many other countries have healthier populations than the U.S.—at lower cost than we pay in the U.S. Americans, with their love affair with free-markets, will need to find a particularly American solution to the problem that is as successful as the healthcare programs in about 40 other countries. We must discover a general set of principles that cut through the Gordian knot. We have not been in this situation before, so we must create and manage 21st century healthcare without the benefit of precedent or historical data. Fortunately, there is a set of general principles in the theory of Complex Systems that may apply to the healthcare dilemma. It is these principles that we will apply—but perhaps not rigorously— to healthcare in this blog and in future blogs. The principles provide us with a high-level roadmap and a means for organizing our actions. But first, just what is a complex system?