Healthcare Delivery as a Service System: Barriers to Co-Production and Implications of Healthcare Reform

Abstract

Both during and after the recent reform efforts, healthcare delivery has been identified as the key to transforming the U.S. healthcare system. In light of this background, we borrow from systems engineering and business management to present the concept of service co-production as a new paradigm for healthcare delivery and, using the foresight afforded by this model, to systematically identify the barriers to healthcare delivery functioning as a service system. The service co-production model requires for patient, provider, insurer, administrator, and all the related healthcare individuals to collaborate at all stages – prevention, triage, diagnosis, treatment, and follow-up – of the healthcare delivery system in order to produce optimal health outcomes. Our analysis reveals that the barriers to co-production – the misalignment of financial and legal incentives, limited incorporation of collaborative point of care systems, and poor access to care – also serve as the source of many of the systemic failings of the U.S. healthcare system. The Patient Protection and Affordable Care Act takes steps to reduce these barriers, but leaves work to be done. Future research and policy reform is needed to enable effective and efficient co-production in the twenty-first century. With this review, we assess the state of service co-production in the U.S. healthcare system, and propose solutions for improvement.