Overview of the U.S. Healthcare System

HLTH 207: Healthcare in the US Lecture 2: Overview of the U.S. Healthcare System

Lecture 1 Recap

  • Personal Trade-Off Policy

    • Interrelated parts or components that cooperate in some way.

    • Addressing structures that must change based on their environment to survive.

    • A scientific framework for understanding the complexity of a system as an interconnected whole rather than as isolated components.

    • Emphasis on mathematical, computer-based modeling for framing, understanding, and discussing system complexity.

  • Assignment Overview

    • Discussion/Assignments/Attendance: 25%

    • Peer Reviewed Journal Articles Reviews, Research Analysis: 20%

    • Letter to Senator/Presentation: 30%

    • Tests: 25%

  • Healthcare Systems as Complex Adaptive Systems

    • Systems thinking

    • System dynamics

Complex Adaptive Systems

  • Definitions and Features

    • Consist of diverse agents (i.e., people).

    • Agents are information processors capable of exchanging information with each other and their environment.

    • Agents adjust their behavior based on the information processed within the healthcare organization.

    • Each individual must contribute to the overall function of the system.

  • Interconnections

    • Represent nonlinear relationships among agents.

    • Inputs are not proportional to outputs, meaning small changes can lead to significant effects while large changes may produce minimal effects.

  • Self-organization

    • Characterized by a decentralized, bottom-up co-design process.

    • New structures and behaviors emerge spontaneously as agents self-organize into stable patterns of relationships.

  • Emergence

    • The behavior of a complex adaptive system (CAS) cannot be determined by summing the behaviors of individual parts.

    • Emergence arises from the patterns of connections among diverse agents and is a source of novelty and surprise.

  • Coevolution

    • CASs and their environments co-evolve, fundamentally influencing each other's development.

    • Organizations act and others react, often in unpredictable ways.

Complexity of Healthcare System

  • Characteristics of Complex Systems

    • Tend to be self-stabilizing.

    • Utilize feedback loops to balance smaller subsystems with the larger complex system.

    • Are purposeful and comprised of individual parts working towards a common goal.

    • Capable of feedback modification and environment modifications.

    • Can replicate, maintain, repair, and self-organize.

Activity: Identifying Complex Adaptive Systems

  • Participants are encouraged to

    • Individually identify a CAS of interest.

    • Recognize and share the characteristics it demonstrates:

    • Multiple interconnected components (e.g., various healthcare providers, departments, technologies).

    • Adaptive behavior in response to patient needs and outcomes.

    • Emergent properties where system outcomes exceed the sum of individual parts.

    • Feedback loops.

    • Non-linear responses.

    • Self-organization without central control.

  • Group discussions to share identified CAS characteristics.

Health System Definition

  • WHO Definition: “The sum total of all organizations, institutions, and resources whose primary purpose is to improve health.”

  • Determinants of Health: Varied factors affecting the health status of populations or groups, which interact and are interrelated to produce different health outcomes.

Population Health

  • Defined as the distribution of health outcomes within a population, the determinants influencing this distribution, and the policies and interventions affecting these determinants.

Complexity in Healthcare Analysis

  • Importance of analyzing complex adaptive systems in healthcare, considering the role of the agents involved.

Systems Theory

  • Systems Thinking:

    • Assessment of interactions and interdependencies among parts of a system to discover sustainable solutions.

    • Valuable in navigating changes in the healthcare context, addressing fragmentation and lack of coordination.

  • Systems Dynamics:

    • Involves mathematical and computer simulation modeling framed for understanding system complexity.

Causal Loop Diagrams

  • Components:

    • Reinforcing Loops (R)

    • Balancing Loops (B)

  • Uses of Causal Loop Diagrams:

    • Identify driving gaps in the system and their timing.

    • Assess knowledge of each gap.

    • Monitor gaps and explore solutions to close them.

Activity: Causal Loop Diagram Sketching

  • Group activity designed to

    • Propose a healthcare-related process for mapping.

    • Sketch a causal loop diagram for their chosen process.

Stock Flow Model Development

  • Steps:

    1. Develop a systems map (e.g., causal loop diagram) for overall system structure.

    2. Define key variables and their types (stock, flow, endogenous, exogenous).

    3. Construct the basic structure of a stock flow diagram.

    4. Collect data and establish variable relationships.

    5. Calibrate a simulation model, adjusting parameters as necessary.

    6. Conduct sensitivity analysis.

    7. Design and evaluate policies.

    8. Determine optimal policies.

Stock Flow Model in Patient Flow and Care Delivery

  • Example Elements:

    • New symptoms arising during lighter service forms.

    • New symptoms post-appointments resulting in wait times for assessment.

    • Guiding patients to appropriate appointments.

    • Balancing patient flow and care delivery processes.

Health System Building Blocks

  • WHO's Six Building Blocks include:

    • Service delivery

    • Health workforce

    • Health information

    • Medical technology

    • Health financing

    • Leadership and governance

  • Purpose: To help understand health systems and identify improvement opportunities.

The IHI Triple Aim

  • Developed by the Institute for Healthcare Improvement, focusing on:

    • Improving the patient experience of care.

    • Enhancing population health.

    • Reducing per capita healthcare costs.

Major Subsystems of U.S. Healthcare Delivery

  • The U.S. healthcare system lacks integration and coordination, leading to multiple subsystems developing through market forces and policy initiatives.

Distinguishing Characteristics of the U.S. Health System

  • Influenced by a culture of self-reliance, aversion to high taxes, and limited government preference.

  • Paradoxical sentiment: Americans see a need for major reform while often satisfied with personal healthcare experiences.

Continuing Challenges in U.S. Healthcare

  • Deficiency in a centralized healthcare system, resulting in costly, unequal access and average healthcare outcomes.

  • Conflicts between market justice and social justice and the balance of power among multiple players.

Exit Poll and Survey

  • Participation in exit poll and survey is required, counting towards your grade.