Engineering an American Healthcare System
A Few Thought Starters using System Engineering & Design Principles
Identify the Goal of the Project - Mission Statement
"Develop a U.S. Healthcare System Resulting in the American People being the Healthiest and Best Cared for in the World at the Lowest Possible and Affordable Cost "
Determine the Scope of the Project
(Preliminary Partial List Below)
Basic Medical Care from Birth to Death
Role of Employers (if any)
Role of Government (Federal vs. State)
Health and Fitness in Schools
Research by Universities and Government
Care both Before and after Retirement
Regulations on Providers
Drugs (Development, Distribution, & Cost)
Role of Private Insurance Companies
Economic Feasibility (% of GDP)
Related Tax Policy
Legal Liabilities
Responsibility of Individuals
Exercise and Fitness Incentives
Care for Veterans
Impact of Alzheimer’s
Long Term Care
Benchmark Systems in other Countries
Brainstorm Ideas and Concepts, without Limit or Judgment,
which may Eventually become Requirements
(See Just a few Ideas & Concepts Below)
No American should ever go bankrupt due to the expenses of needed medical care.
The number one cause of personal bankruptcy in the U.S. is unexpected medical costs.
Medical insurance cost and deductibles must be affordable by average income people.
Insurance may not be withheld or premiums increased due to pre-existing conditions.
The above is currently in effect for pre-Medicare individuals. However, those on Medicare currently may be rejected for Medicare supplemental insurance plans.
Dental insurance, should be included as an integral part of medical insurance.
Doctors recognize that proper dental care is required to maintain good health … Dental care should be integral to all medical insurance, not a separate policy. Most retiring seniors loose dental care. Medicare cost then increases due to poor dental health.
Hospitals, designated as “in a given network” should be required to guarantee that patients will not be billed extra as “out of network” by any provider in that hospital.
Patients should never be required, by any hospital, to sign a document agreeing to pay any charges, without limit, not paid by insurance, prior to receiving needed care.
Providers should be required to charge the same regardless of who is paying the bill.
Pharmaceutical companies should be prohibited from advertising prescription drugs.
The greatest problem of drug addiction in the U.S. is with prescription drugs.
Advertising prescription drugs, especially on TV, glamorizes such drugs and undermines the doctor patient relationship. The U.S. and New Zealand are the only major countries that currently allow advertising of prescription drugs on television.
Predatory pricing of required drugs, by pharmaceutical companies, must be prohibited.
The price of prescription drugs is among the greatest of unaffordable costs to individuals as well as Medicare & Medicaid.
Permanent cures should be sought for as many ailments as possible rather than prescribing maintenance drugs for long term or lifetime use.
Although this may be contrary to the financial (profit) interest of pharmaceutical companies it would be best for the patient. Various side effects may accompany long term drug use leading to other health issues and additional medical expenses to individuals and the medical insurance system. An example is using an antibiotic for ten days to cure a bacterial infection, rather than long term drug use to keep it at bay.
Finding cures for certain, even deadly, conditions may not be pursued by pharmaceutical companies if the projected profit of a potential drug, to treat that condition, is not sufficient to justify the cost of such research.
It may be worth considering that Government would fund research for drug development, to treat particular conditions, by contracting pharmaceutical companies to do so. Then any patents would be the property of the American people and any drugs developed would be generic by default. A possible model for this concept is the Government contracting defense companies to develop new weapons systems.
The use of Healthcare Savings Accounts (HSAs) should be re-evaluated.
The purpose of a HSA is to pay for medical expenses with pre-tax dollars. This could be accomplished more efficiently by changing the tax code to allow 100% of the same medical expenses to be deducted directly.
HSAs are a great deal for financial institutions, as a government sanctioned product, for them to offer and charge fees to maintain. In some cases the HSA funds are subject to financial markets. This may be “not so great” for an average individual.
Under current tax law: When individuals turn 65 and sign up for Medicare, they can no longer contribute to a HSA. (This is another reason to allow for direct tax deduction).
A possible option would be to allow paying eligible medical expenses from a HSA and deduct 100% of eligible, non HSA paid, medical expenses from income tax.
Evaluate the Ideas and Concepts above for Merit and Feasibility
The Team needs to discuss each idea and concept for merit, feasibility, and immunity from producing unintended consequences. The “Design for Six Sigma” statistical process can be used to select the best of similar competing ideas. Those selected will eventually need to be refined into detailed requirements and integrated into a proposed system.
Solidify and Document the List of Requirements for the System
(Note that All Requirements Must be Met)
The requirements must all be compatible with each other and with the goal of the project. An extensive Failure Mode and Effects Analysis (FMEA) needs to be done to insure that the system will not breakdown under any reasonable combination of adverse events or stresses.
The final requirements would be compiled into a Statement of Requirements (SOR) document. In addition to the requirements any needed explanations, clarifications, diagrams, charts, formulas, drawings, and any other pertinent information should be included.
This SOR can be thought of as the Architectural Specifications and Blueprints of the project.
Develop and Document a Statement of Work (SOW)
(This is a Project Management effort with Engineering Support)
In order to build the requirements into a functional system, the people chosen to do the job must have detailed instructions, time tables, financials, and understand all of the metrics for which they will be held responsible. This is the content of the SOW.
Development and documentation of the SOW is typically a function of Project Management with the full support of Engineering and in most cases Purchasing.
The SOW is given to the supplier, contractor, or in this case a legislative sub-committee chosen to prepare a Bill compliant with the SOR and SOW.
The proposed Bill would be reviewed and concurred with by Engineering and Management. Which in this case, should be a small appointed Leadership Team, making sure that “Special Interests” don’t insert anything that is not in the SOR. Remember: “Too many cooks spoil the broth.” It can then advance in the Legislative Branch, without changes that impact the FMEA.