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July 18, 2012

Understanding Health Care as a Complex System: The Foundation for Unintended Consequences

Author Affiliations

Author Affiliations: Hebrew SeniorLife, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts.

JAMA. 2012;308(3):243-244. doi:10.1001/jama.2012.7551

As the United States embarks on health care reform, policy makers speak of using a variety of levers to control the health care system and its accelerating costs. These levers include a variety of regulations that are enforced through surveys, certifications, payments, and penalties. However, these mechanical approaches often lead to unintended consequences. This is due to the enormous complexity of the health care system—both in lay terms by its complicated design and in scientific terms by its nonlinear, dynamic, and unpredictable nature. To help guide future policies and avoid the unanticipated consequences of regulation, policy makers and physicians need to understand health care as a complex system and apply the principles of complexity science to achieve its goals.