Declining Marginal Returns of Complexity

June 21, 2010

Just completed the book The Collapse of Complex Societies by Joseph Tainter, an archeologist. The focus of the book is on civilizations like the Roman Empire and the Mayas but it made me wonder about the complexity of health care and whether we are at the point of declining marginal returns.  It is apparent from the health care reform experience that competing stakeholders make any attempt at reform a complex and nearly impossible process. Clay Shirky wrote a blog post in April on The Collapse of Complex Business Models. Just like societies which become too complex to respond to major stressors.  While I am not predicting the collapse of health care in the US but one must wonder whether some of the complexity could be simplified by the experience of other countries, such as, single payer systems and an emphasis on primary care (medical home).  Would be interested in other opinions, especially from those who have read the book.

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One Response to “Declining Marginal Returns of Complexity”

  1. DF says:

    I was searching on the marginal returns phrase related to another topic, but since I wound up here, and I was just thinking abt the healthcare system, I will give you a reply.

    Having lived both in NZ and USA and experienced the healthcare systems in each, I can confirm for you your suspicions about the level of complexity in the USA. What is the majority of this about? Much is about this question: Who is going to pay?

    Take a routine procedure such as a cholesterol check. First there’s the blood draw. If this occurs at a separate facility, you get your first round of paperwork and, Who is paying? Then you’d like a PCP, or even a cardiologist, to sit and go over the results. Again more paperwork and, Who pays? A huge amount of manpower gets diverted processing all the permutations for this, for what should amount to inexpensive procedures that we should be _encouraging_ people to participate in.

    In comparison in NZ you can go to any one of a number of facilities for the blood draw, you are in-out with no paperwork or fees save for where to send the results. The doctor consultation is accessible and inexpensive, $36NZD, which amounts to maybe $30 US for the entire thing. Pay at exit.

    I can only imagine the back office team at work in a US doctor’s office processing the documentation for this sort procedure, all to sort out the deductibles, verify coverage, copays, and all the minutia of every individual’s program and circumstances.

    To me this sort of treatment in the US is ALREADY broken, because while you can get something done, many people won’t due to the obstacles thrown up by for-profit medicine. Your PCP won’t know you – if you are lucky enough to have one, as employers jump from plan to plan – and the one who sees you likely won’t communicate well with any specialists and others involved in diagnosis and treatment, should it come to that. Too much time pressure, always another patient to see and a pile of forms to process. There are exceptions (and exceptional individuals) in the US, and that largely comes down to unique physicians and how they decide to run their practice.

    It’s just easier to provide good care when the system itself is designed to support it.

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