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September 05, 2011

The Healthcare Dilemma Simplified

As an otolaryngologist in private practice, I have observed from the sidelines the healthcare crisis that is brewing in our nation, being debated in Congress, and bemoaned by fellow colleagues.

Being a simple man, I see the essence of the healthcare problem being summarized in one sentence:

"How to deliver low-cost, high-quality healthcare cheaply."

Being a simple man, I also realize that this statement is nearly impossible to accomplish for something as complex as healthcare delivery.

It's also a concept engineers have struggled with for way longer than medicine has. It is summarized by a great graphic known as the "Engineering Project Triangle". What is achievable is only where the colors overlap.




Design something quickly and to a high standard, but then it will not be cheap. 

Design something quickly and cheaply, but it will not be of high quality.

Design something with high quality and cheaply, but it will take a long time.

In other words, you can only pick two.

In terms of healthcare, the triangle could be known as the "Healthcare Project Triangle."



Design healthcare that is able to provide quality care at low-cost, than not everyone can have it. It's also known as "rationed" care which is what Canada and Great Britain have to some degree.

Design healthcare that is able to provide quality care to everybody, it will be expensive. This is where our healthcare model is currently situated.

Design healthcare this is able to provide low-cost care to everybody, it will suffer in terms of quality. Some would argue this is the HMO model. It's also what we could consider the kind of healthcare that is provided in free clinics.

In essence, you can't have healthcare with all three characteristics. You can only pick two.

Engineers know that and are probably wondering why doesn't everybody else.

"You can only pick two" is what the great debate is all about. Nobody can decide on which two and there are FANTASTIC arguments for the given two a Senator or presidential candidate will promote.

However, in the end, either quality, quantity, or low cost will suffer no matter which healthcare policy is chosen.

So the great debate has been identified...

The great question is what will be sacrificed?

Because unfortunately, there is no great answer.

Reference:
When Nurses Wear "Do Not Disturb" Signs. Dr. Wes.
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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