Una nuova visione dell'assistenza sanitaria

NEW YORK – I sistemi sanitari tradizionali sono in difficoltà. Nei paesi dell'OCSE, i servizi sanitari sono prevalentemente gestiti da ospedali e cliniche costosi, che rappresentano il 97% della spesa degli Stati Uniti per l'assistenza sanitaria. Assillati da vincoli di costo, una domanda di qualità sempre migliore e aspettative esagerate, questi sistemi stanno letteralmente annaspando.

Esiste, però, un sistema di tipo diverso, largamente diffuso nei paesi più poveri che non possono permettersi ospedali simili a quelli occidentali, che è incentrato sull'assistenza sanitaria di comunità.  Entrambi gli approcci sono necessari ed è necessario che si integrino a vicenda. Di fatto, il crescente divario tra le promesse della sanità e la sua realtà ha creato, tanto nei paesi sviluppati quanto in quelli in via di sviluppo, uno spazio per nuovi attori più interessati al comportamento sociale che alla biologia.

Nel suo influente articolo pubblicato sulla Harvard Business Review nel 1996, W. Brian Arthur ha evidenziato le grandi differenze che distinguono un sistema sanitario caratterizzato da pianificazione, gerarchia e controllo da un altro basato su osservazione, posizionamento e organizzazioni orizzontali. Il primo, sostiene Arthur, punta ai materiali, all'elaborazione e all'ottimizzazione, è principalmente focalizzato sull'accesso alle cure mediche ed è in genere esposto a una decrescita dei rendimenti.

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