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Fixing Healthcare by Fixing Healthcare Delivery

Walter Russell Mead

While the press corps and the political world obsess over the presidential race, other Americans are, fortunately, getting on with their lives. In the field of medical education, there’s even been a breakthrough. Becker’s Hospital Review reports:

The American Medical Association unveiled a formalized strategy Tuesday to revamp medical education, complete with a textbook to support the emerging curriculum.

The new strategy adds a third area of study to medical education: health systems science. This third pillar, which will be added to basic and clinical science, covers value-based care, patient safety, quality improvement, teamwork, leadership, clinical informatics, population health, socioecological determinants of health, healthcare policy and healthcare economics.

"We know that the way healthcare is being delivered is changing, but until now those changes have not been widely incorporated into the way we teach our physicians. Our medical schools are very good at preparing students for the basic and clinical sciences that are paramount to providing care to patients, but what is largely missing is how to deliver that care in a complex health system," AMA CEO James Madara, MD, said in a statement.

The next generation of doctors is going to start off by studying one of the most important, but most poorly understood—and dysfunctional—areas of health care: the systems through which it is delivered and organized.

Making the systems that make up the health care system more effective and less expensive may well emerge as the critical research frontier in health science in years to come. Currently, we have a mix of public single payer, private insurance, for profit, not for profit and other models—with lawyers scrutinizing everything, special interest lobbies capturing the regulatory authorities, and incomprehensible “reform” bills that nobody reads. Clearing up this epic tangle and putting American health care on the path to sustainable reform is one of the most important tasks that the aging Boomers are leaving behind them as they head for the Great Waterbed in the Sky.

Let’s hope that as young physicians and others learn more about how hospitals and other health institutions work, they will begin to think about how to improve them. Perhaps successive editions of these new textbooks will reflect more and more progress until, at some point in the not too distant future, Americans have health care systems that deliver better care at lower cost.

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