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by Yaneer Bar-Yam
Step I: Separate Simple Care

Healthcare work may be divided into two types: simple care, which is the same for many people, and complex care, which is different for each individual.

Simple care includes preventive services, such as health screenings, vaccinations, and healthy-habits counseling sessions. Complex care includes the individualized diagnosis and design of treatment.

Physicians are specially trained to diagnose and treat complex medical conditions. Nonetheless, one finds that physicians and their offices are typically responsible for simple, standard care in addition to complex, individualized care.

That poses a problem. Asking the same organizational structure to provide mass-applicable preventive care and complex individual care is like asking an expert violin craftsman to provide all the chairs for a new concert hall. The mismatch between the organization and the task leads to ineffectiveness and inefficiency.

Ironically, instead of streamlining the delivery of high-volume simple services, most cost-reduction efforts to date have tried to make complex tasks simpler and faster. Industrial-style efficiency is poorly applicable to doctors' diagnoses and treatment of individual patients, however. Trying to speed and simplify doctors' work assembly-line style reduces doctors' time to make complex decisions, which is not a good idea if we want doctors to be careful and make the best decisions possible. At the same time, many healthy patients are receiving insufficient preventive care, since doctors are being asked to provide many of these services. The volume of preventive care needed is too great for the current system to handle it effectively.

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