Challenges in Healthcare Delivery

We are currently embroiled in two healthcare debates. One debate involves how the costs of making healthcare available to everyone should be apportioned among individuals, employers, and the government. The second debate concerns how to achieve reductions in the high costs of healthcare to provide the best value. Both debates have to be resolved effectively to achieve our goals.  Only addressing one – by, for example, solely making everyone insured – may worsen our cost problems by having many more people demanding very expensive, and sometimes marginally effective care.

Which of the seven challenges is predominant in this situation?  Cost growth is obviously a major concern.  However, we might recast the growth challenge in terms of the extent to which the high costs incurred yield value relative to fostering a healthy, educated, and productive population.  Perhaps this is too grandiose.  Why not just seek the lowest cost healthcare system?  That would be easy.  We might even be able to achieve a zero cost healthcare system.  However, if the consequences of this perspective are not appealing, then we need to address the central tradeoffs between value and cost.

This, of course, begs the fundamental question of what value means in healthcare.  My sense is the highest value healthcare would be such that people would be well and not need attention to debilitating diseases.  I heard this expressed as follows, “I want to die young, as late in life as possible.”  It would be great if the second healthcare debate indicated above could focus on this possibility.

By the way, note that the challenges of focus, change, future, knowledge, and time cannot be central until we agree on the foundation of value that we collectively want.


  1. Interesting questions. I agree that central to the problem is defining what value means. Dr. Dominic Thomas (Goizueta) and I suggest the two predominant ways of framing value are in conflict with each other, which exacerbates the challenge of stakeholder management fundamental to advancing any solution. See

    John Schlichter

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