Improving the effectiveness of health care and public health: a multiscale complex systems analysis

Am J Public Health. 2006 Mar;96(3):459-66. doi: 10.2105/AJPH.2005.064444. Epub 2006 Jan 31.


The US health care system is struggling with a mismatch between the large, simple (low-information) financial flow and the complex (high-information) treatment of individual patients. Efforts to implement cost controls and industrial efficiency that are appropriate for repetitive tasks but not high-complexity tasks lead to poor quality of care. Multiscale complex systems analysis suggests that an important step toward relieving this structural problem is a separation of responsibility for 2 distinct types of tasks: medical care of individual patients and prevention/population health. These distinct tasks require qualitatively different organizational structures. The current use of care providers and organizations for both purposes leads to compromises in organizational process that adversely affect the ability of health care organizations to provide either individual or prevention/population services. Thus, the overall system can be dramatically improved by establishing 2 separate but linked systems with distinct organizational forms: (a) a high-efficiency system performing large-scale repetitive tasks such as screening tests, inoculations, and generic health care, and (b) a high-complexity system treating complex medical problems of individual patients.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Efficiency, Organizational*
  • Health Services Administration*
  • Humans
  • Insurance, Health
  • Public Health Practice*
  • Reimbursement Mechanisms
  • Systems Theory*
  • United States