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The iron triangle and the chrome pentagon

R B Donker1, J A Ogilvy

  • 1Global Business Network, Emeryville, CA.

The Healthcare Forum Journal
|October 5, 1993
PubMed

Insights

The healthcare system, driven by fear and finance, mirrors an arms race and resists incremental changes. Fundamental reform is necessary for progress.

Area of Science:

  • Health policy
  • Healthcare economics
  • Systems science

Background:

  • The current healthcare system operates on a complex framework of incentives.
  • These incentives are significantly influenced by financial motivations and fear-based decision-making.
  • Analogous to an arms race, the system's structure resists gradual adjustments.

Purpose of the Study:

  • To analyze the incentive structures within the healthcare system.
  • To draw parallels between healthcare and the arms race regarding reform.
  • To highlight the inherent resistance to piecemeal reform in healthcare.

Main Methods:

  • Conceptual analysis of healthcare system incentives.
  • Comparative framework analysis using the 'arms race' model.
  • Literature review on healthcare policy and reform.

Main Results:

  • Healthcare incentives are predominantly driven by financial gain and risk aversion (fear).
  • The system's structure mirrors the escalating and self-perpetuating nature of an arms race.
  • Incremental reforms are insufficient due to the deeply embedded nature of these incentives.

Conclusions:

  • The healthcare system's incentive framework, fueled by fear and finance, prevents effective piecemeal reform.
  • Systemic, rather than incremental, changes are required for meaningful healthcare transformation.
  • Understanding this dynamic is crucial for developing effective healthcare policy.

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