Eine neue Welt des Gesundheitswesens

NEW YORK – Die traditionellen Gesundheitssysteme stecken in Schwierigkeiten. In der OECD werden die Gesundheitsdienste durch teure Krankenhäuser und Kliniken dominiert, auf die 97% der Gesundheitsausgaben der Vereinigten Staaten fallen. Diese Systeme sind im Zuge von Kostenbeschränkungen, öffentlicher Nachfrage nach höherer Qualität und überzogenen Erwartungen in Schwierigkeiten geraten.

Aber vor allem in ärmeren Ländern, die sich Krankenhäuser nach westlichem Vorbild nicht leisten können und ihr Gesundheitswesen kommunal organisieren, gibt es andere Systeme. Wir brauchen beide Ansätze und müssen sie miteinander in Einklang bringen. In der Tat hat der wachsende Graben zwischen dem Versprechen und der Wirklichkeit des Gesundheitswesens – in Industrie- und Entwicklungsländern – Raum für neue Akteure geschaffen, denen es mehr um soziales Verhalten als um Biologie geht.

W. Brian Arthur hat in seinem bahnbrechenden Artikel von 1996 im Harvard Business Review die wichtigen Unterschiede zwischen einem Gesundheitssystem, das durch Planung, Hierarchie und Kontrolle bestimmt ist, und einem, das auf Beobachtung, Positionierung und flachen Hierarchien beruht, dargestellt. In der ersten Art von System, betont er, geht es um Material, Verarbeitung und Optimierung. Das System legt seinen Hauptschwerpunkt auf den Zugang zu medizinischer Versorgung und leidet normalerweise unter einem abnehmendem Grenzertrag.

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