| Summary: |
Breakthroughs in medical science along with innovations in clinical practices
and related technologies offer enormous opportunities for impressive
improvements in the health and well-being of society. Returns on investments
in these endeavors have the potential to be substantial, sustainable,
and broadly beneficial. However, we will not realize the greatest returns
with our current fragmented system of healthcare delivery (Reid et al., 2005;
Rouse & Cortese, 2010). Many see a need to engineer or design a system
that can provide high quality, affordable healthcare for everyone. Engineering
healthcare delivery will require that the current nondesigned enterprise
be substantially transformed (Rouse, 2006a). This book is intended to
be an important enabler of such fundamental change by providing and
illustrating concepts, principles, models, and methods for understanding
and improving the efficiency, effectiveness, and equity of healthcare
delivery.
This chapter proceeds as follows. We first discuss the nature of the
problems associated with the current healthcare delivery system in the
United States. This includes the forces driving needs for change, the types
of issues that need to be addressed, and the complexity of these issues.
We then address the objectives that transformation should be designed
to achieve in terms of high-value healthcare, including definitions of
value, how it is delivered, and the roles of information and incentives
in providing value. We next consider alternative approaches to solving
healthcare delivery problems, contrasting bottom-up and top-down
approaches and the use of quantitative approaches to explore a wide range
of solutions.
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