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Wednesday, February 10, 2010

Chaos and Organization in Health Care

If the health care delivery system is going to deal effectively with the issues of cost and quality, it will have to get organized.

That is the theme of a book I have just finished reading. Its title is Chaos and Organization in Health Care. It was written by Dr. James Mongan, CEO of Partners Health Care System (now retired) and Dr. Thomas Lee, Network President, Partners HealthCare System. Partners Health Care System consists of the Massachusetts General Hospital, Brigham and Womens Hospital, and several other facilities in the Boston area.

I read the book at the urging of fellow parishioner Brian Baldwin, to whom I am most grateful.

This blog was started as a forum for discussion of what a reformed health care system should look like. To the best of my knowledge, Mongan and Lee have presented for the first time a coherent proposal on that topic.

As a basis for doing so, the authors have displayed the current health care delivery system along a graph with two axes – one showing a range of payment methods and the other a range of organizational forms. At one extreme is the solo practitioner paid fee-for-service (chaos). At the other is a fully integrated delivery system like the Kaiser HMO or the Geisinger Clinic in Pennsylvania, paid by means of capitation (organization).

Their proposal is that the system of health care delivery and finance ought to move away from chaos and towards organization. They point out that it has moved a considerable distance in that direction already, but that the pace ought to be accelerated.

I couldn’t have said it better myself.

If President Obama and the US Congress would propose such a program, that would be something I could enthusiastically support.

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