Information as Change Agent or Barrier in Health Care Reform?

Information as Change Agent or Barrier in Health Care Reform?

Alan C. Gillies, John Howard
DOI: 10.4018/978-1-4666-2797-0.ch001
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Health care systems across the world are in a state of flux. If the experience of the early 1990s can be used as a model, the recent global economic downturn will lead to very significant pressures to reduce spending and achieve better value. Systems have provided a range of approaches to modeling and evaluating these more complex organizations, from simple process models to complex adaptive systems. This paper considers the pros and cons of such approaches and proposes a new modeling approach that combines the best elements of other techniques. This paper also describes a case study, where the approach has been deployed by the authors. The case study comes from health care services in Ontario, Canada, who are shifting from the traditionally hospital-based system to one that recognizes a greater role for community and primary care services.
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Drivers Of Innovation In The Health Care Sector

In 2008 and 2009, the national economy of many countries has shrunk. The last time the world economy experienced a recession, in the early nineties, it led to a major panic about the cost of public services, and in particular health care, where a sharp rise in the perceived cost of health care services led to many explanations such as increasingly elderly populations, increased cost of drugs and medical technology. These explanations have not been wholly supported by more reflective analyses, as described in Gillies (2003).

Drug Costs are offset by reduced hospital admissions, where new treatments allow treatment in the community, and keep patients out of hospital e.g. increased use of sophisticated and more expensive asthma treatments is offset by reduced numbers of emergency admissions, and in non-financial terms by prevention of distressing patient episodes. Although a more elderly population does require more care, the largest medical costs remain the months prior to death, irrespective of age.

A key concern for many governments is the cost of health care. Indicators published by OECD (2009) measure the affordability of health care, so measure costs relative to GDP, rather than absolute costs. Affordability reduces in a recession, leading to a higher figure (Table 1).

Table 1.
Health care costs in the 1990s
Health Care Cost as %GDPHealth Care Cost Per Head US $
CanadaFranceGermanyUnited KingdomUnited StatesCanadaFranceGermanyUnited KingdomUnited States

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