Research Activities, February 2014
Lessons from the U.S. educational system for the health care system
Patient Safety and Quality of Care
Health care delivery in the United States is fragmented, with no central structure or organization. Achieving an organized health care delivery system will require radical change. In this commentary, the authors envision how radical system-level reform might borrow from another public sector: education. Their proposed solution for the U.S. health care system is modeled after an admittedly idealized version of the U.S. public education system, with a mix of public and private providers governed by regional planning, organization, and oversight.
Their model envisions a national system of community health centers (CHCs) administered by community district health boards (similar to school boards) whose members are elected periodically. These boards would have the authority to supervise central administration, balance budgets, and conduct systemwide strategic planning. Each district's system of CHCs would provide comprehensive public health, preventive health, and primary care services. The boards would also obtain secondary and tertiary care services by direct provision or contract. All CHCs in a given district would use the same electronic medical record system. Much of the funding for this system would come from existing public insurance dollars divided up by district, with allocations based on population measures of health and health care needs.
The authors hope to encourage creative thinking about other system-level communities of solution that could lead to profound change and improvements in the U.S. health care system. This study was supported in part by AHRQ (HS16181, HS18569).
See "Community of solution for the U.S. health care system: Lessons from the U.S. educational system," by Jennifer E. DeVoe, M.D., and Rachel Gold, Ph.D. in Journal of the American Board of Family Medicine 26, pp. 323-326, 2013.