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AJPH First Look, published online ahead of print Jan 31, 2006
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March 2006, Vol 96, No. 3 | American Journal of Public Health 459-466
© 2006 American Public Health Association
DOI: 10.2105/AJPH.2005.064444

OPPORTUNITIES AND DEMANDS IN PUBLIC HEALTH SYSTEMS

Improving the Effectiveness of Health Care and Public Health: A Multiscale Complex Systems Analysis

Yaneer Bar-Yam, PhD

The author is with the New England Complex Systems Institute, Cambridge, Mass.

Correspondence: Requests for reprints should be sent to Yaneer Bar-Yam, PhD, New England Complex Systems Institute, Cambridge, MA 02138 (e-mail: yaneer{at}necsi.org).

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.






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Copyright © 2006 by the American Public Health Association