Healthcare Systems are Complex and Need Strong Management

In August 2017, parents watched helplessly as more than 60 babies, diagnosed with encephalitis from mosquito bites, died due to lack of oxygen at a hospital in Gorakhpur, UP, because suppliers’ bills of INR 68 lakhs had not been paid. Such news is made even more tragic when India, in stark contrast, claims to be the lowest cost provider of the highest quality care in the world.

Post such an event, questions get raised and the usual causes get flogged in public: corrupt administrators, low government spend, poor sanitation, incompetent or absent doctors, inadequate supplies, etc. After an appropriate period of ennui, the nation moves on until the next tragedy that is inevitable and imminent.

Gross negligence and such obvious causes, though difficult to digest, are easy to understand. Our real quest, the Holy Grail, should be to eliminate any and all errors that prevent us from delivering the best modern science has to offer and delivering the same to all. Anticipating and correcting or preventing the errors created in healthcare delivery systems is a larger systemic challenge. The healthcare system is characterized by several major factors that are enlisted below.

Knowledge

First, there is the science of medicine. There are estimated 10,000-30,000 diseases known to us that affect humans, of which only a few (500-1,000) have a known cure. There are over 4,000 diagnostic lab tests, over 400 imaging tests and interventions, about 12,000 drugs, approximately 600-1000 procedures. Medical practitioners build up their skills over 60 main specialties and several hundred subspecialties. This knowledge base is constantly updated and modified so fast that even the best practitioners find it very hard to keep up.

Complexity

Then we have the complexity of the vulnerable and disease-prone human system that is designed to die from the moment it is born. Over 100 billion cells, 78 organs (11 complex large organs) and 12 interdependent systems make the human body – ever-changing, continuously monitoring, detecting, and self-healing. The National Institute of Health, USA now estimates that over 400,000 people die unnecessarily each year in the US alone due to medical errors making it the third leading cause of death.

Environment

Last, but not least, we have the environment; viruses, fungi, and protozoa. Add to this diet, sunlight, exercise, nutrition, stress, sleep, road accidents, murders, and natural calamities.

This vastly-complex intersystem of medicine, the human body and environment is also both dynamic and fast changing. The human body is subject to more stresses, less rest. The environment is more toxic, the air more polluted, the food more artificial (with high sugars and high hormones), medicine is more segmented and intrusive. All of this creates the market conditions for supply and demand of healthcare. We are willing to pay for the right to live a little longer. Sanitation, vaccinations, antibiotics, heart surgery, wound management, and healthier diets and environment have helped us raise our life expectancy from 30 to current 78 years.  But this is neither uniform nor guaranteed at an individual level.

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