I was reading an article in the New England Journal of Medicine about Accountable Care Organizations last night and was reminded of “path dependence” as an explanation of why healthcare is in the state it is in today. A summary of what these organizations should be able to do is found below

What’s not to like? Turns out there some barriers in moving from our current system to our new system. The first is that doctors do not work well together to deliver coordinated care. Sandbox was not our strongest subject in school. Secondly, physicians have been especially slow to embrace technology (if the stethoscope was good enough for Laennec, it should be good enough for me). You can get your money on another continent but not your health records. Lastly, hospitals have been the capital engine of the health care market and it is possible they may not relinquish control.

This last point illustrates the problem of path dependency. As discussed in the article

Established institutional relationships tend to persist because of “path dependence”: decisions about the future are constrained by decisions made in the past, even though circumstances may change. Although it is unequivocally inefficient, inequitable, and otherwise problematic to finance health care with a combination of employer-based coverage, Medicare, and Medicaid, it has proved impossible to change this structure.

Why work to change course? If you have to ask this, read this post.

Addendum: The president’s oil spill commission came out and said that most of the oil money should go to environmental restoration, to the dismay of Alabama coastal economic leaders. As I discussed previously here, part of the proposal was to strengthen primary care in the region so I should be disappointed but in truth I think they are correct. At any rate, you can still hear the croud chanting “Monorail, monorail, monorail!”

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