Category Archives: Health Care

Health Care – The bureaucratic sum of my parts

by Larry Grant

In the past year I’ve spent far too much time intimately involved with the health care system.  The really obvious pain, of course, is the insurance and payment system.  If you’ve got only one bill, or one provider, or you’re the only one covered by your insurer, it’s not a big deal to figure out what’s going on — who owes what to whom.  However, whenever it gets beyond that, you need a professional (or compliant spouse or offspring) to figure out the bills from the “not-a-bills,” etc.

Not so obvious, but it struck me the other day as a “blinding flash,” is the basic bureaucratic structure of the system.  Three of the main characteristics of a bureaucratic organization, straight out of the industrial age paradigm are specialization, hierarchical control, and the dependence on processes, rules and procedures. Bureaucracy works well in two basic conditions.  First, there is little or no change in what the processes/rules/procedures need to be applied to.  For example regulating food safety in an era when most of our food was produced domestically is different from today’s globalized food market.  Second, the specialized organizational structure has a good fit to the presenting problems a constituent faces. For example, if you live in a city or county where there is no “dead animal disposal” department, try to figure out which part of government is willing to help — public works? Roads? Animal control?

One of the most frequent criticisms of bureaucratic organizations, especially government, is that it is next to impossible to find the “right person” to talk to — i.e., being bounced from agency to agency, desk to desk, to find the right place to get the service you require.  Once you do find the right person or place, you can get great service.  However, if the service required does not fit well within the given organizational structure, then it may be literally impossible to get service without a “case manger” to help the uninitiated navigate the system. (Remember when Mr. Incredible tries to help the little old lady get the right form to the right person in the insurance agency?)

Over the first 60+ years of my life, I’ve gotten great service from the health care system.  But in the last year this system has had to deal with more than one of my systems — pulmonary, circulatory, urological, and things are not working so well.  In the last year, I have seen and been treated by some of the very best medical people in the country (maybe in the world) — internists, hospitalists, surgeons (of several types), cardiologists, pulmonologists, oncologists, urologists, radiologists.  They are great at dealing with their “thing.”  Their “thing,” however, is not me — it’s just part of me.

Like allopathic medical practice in general, the health system is focused on the disease, not the “customer.” (There, I said it again.) While the best businesses and government agencies have learned that focusing on the customer improves performance, in large measure, the health system does not. And I’m not even talking about the insane Diaspora between the health delivery system and the health payment system that our wise and wonderful leaders have concocted and I already kvetched about earlier.

The bottom line is that the current disease management system doesn’t focus on me, or you, or any other person. This suggests a way of thinking about solutions.

What do you think might be in the post-bureaucratic solution set? Hint: I’m off to the Mayo Clinic to see what they have to offer.

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