Wired Science

Health care is a morass, a quagmire, a slough of policy despond, but perhaps complexity science can help chart a path forward.

On the day of the Supreme Court's landmark ruling, researchers from the New England Complex Systems Institute released an eight-step prescription of network theory to America's ailing health system.

"What makes organizations successful or unsuccessful? The underlying principle is matching scale and complexity to task," said Yaneer Bar-Yam, president of NECSI, which in earlier analyses looked at rising food prices, the 2008 financial crisis and even the dynamics of social violence.

Titled "A Complex Systems Science Approach to Healthcare Costs and Quality," the white paper is isn't peer-reviewed, and represents a mix of policy analysis and informed extrapolation of complex systems principles to health care.

Complexity researchers might seem an odd source of health reform inspiration -- but with U.S. health care more expensive and less effective than in other developed nations, inspiration from unexpected sources is most welcome.

On the following pages, Wired looks at the NECSI recommendations.

Retail Clinics

One of the great shortcomings of late-20th century American health care was its emphasis on disease treatment rather than prevention. Preventive care -- such as screening people for cancer, helping them quit using tobacco, or providing flu shots -- is both common-sense and cost-effective. However, NECSI calculates that providing effective, nationwide preventive care through doctors' offices would require hiring 400,000 full-time workers.

The solution: so-called retail clinics that provide simple, routine services separate from standard physician practices. There are already more than 1,200 retail clinics in the United States, many located at places like Target and Walmart, but their usefulness has been debated. NECSI calculates that a national system of retail clinics would reduce preventive costs by a factor of five.

"You don't want both highly complex tasks and repetitions of simple tasks done by the same organization," Bar-Yam said. "In the health care system, that distinction is not generally made. Physicians responsible for diagnosis and treatment are also responsible for giving flu shots. They are not placed in an organization designed for efficiency."

Moving certain services away from doctors and into malls may feel strange, but it's worth remembering that before the rise of specialized pharmacies, doctors were expected to mix their own medicines.

Image: Paul Swansen/Flickr

Citation: "A Complex Systems Science Approach to Healthcare Costs and Quality." By Y. Bar-Yam, S. Bar-Yam, K.Z. Bertrand, N. Cohen, A.S. Gard-Murray, H.P. Harte, and L. Leykum. June 20, 2012.