2nd Edition

Paradox and Imperatives in Health Care Redirecting Reform for Efficiency and Effectiveness, Revised Edition

By Jeffrey C. Bauer Copyright 2015
    159 Pages 1 B/W Illustrations
    by Productivity Press

    The Paradox: Americans are not as healthy as people in dozens of comparable countries that spend 30 percent less on health care, and our medical marketplace overall is plagued by persistent problems of cost, quality, and access. Yet, the world’s best individual health systems are located in the U.S.—each a unique result of visionary leadership and private initiative, not government-driven health reform.

    The Imperatives: Due to powerful new forces explained in this book, medical spending has stopped growing. Purchasers, payers, and patients are no longer willing or able to keep paying more. To stay in business and improve population health, providers and their business partners must eliminate the shameful waste generated by inefficient and ineffective production processes.

    The Solution: Simply repairing or repealing the Affordable Care Act will not get us where we want to go. The fundamental roadblock is a wasteful system, not uninsured Americans. Reform needs to be immediately redirected to creating the best health care system that 17 percent of GDP can buy. Money saved by taking the new path to reform can then be used to improve population health through access for all. Paradox and Imperatives in Health Care is the roadmap for getting there.

    • Supplies updated perspectives on health care’s problems and solutions
    • Details the reasons why government-driven reform does not solve problems
    • Provides a justification for regulatory relief tied to performance improvement
    • Suggests specific new policies for a better approach to desired outcomes
    • Presents content written expressly for busy executives and policy makers

    Introduction: The Paradox
    The Paradox
    The Imperatives
    Analytical Foundation for Solutions
    The Target Audience
    Note on Authorship

    The Economic Challenge: Chaos
    End of Growth in Spending: The New Normal
    Dramatic Decline in Overall Economic Growth
    Increasing Demands from Other Sectors
    Constrained Consumer Spending
    Increasing Diversification and Competition
    Improvement in Scientific Indications for Medical Care
    The More Things Change
    The Bottom Line: Redirecting Reform
    Problems with Predicting the Future of Health Care
    Medical Professionalism and Solving Economic Problems

    The Economic Imperative: Efficiency (Cost)
    Short Run versus Long Run
    Tactics versus Strategy
    Key to Success: Long-Run Strategy
    Need for Common Understanding
    Efficiency for Executives
    Problems to Avoid
    Inefficiency Equals Waste
    Enough Waste to Matter?
    Policy: One Size Does Not Fit All
    What to Do with the Savings?

    The Clinical Imperative: Effectiveness (Quality)
    Effectiveness: Compliance with Specifications of Performance
    Neither Cost nor Value
    Why Effectiveness Is an Imperative
    Effectiveness and Quality in Health Care
    Quality: Consistent, Appropriate, and Safe Care
    Redirecting Reform: Performance Standards to Standard Performance
    Limitations of Historical Efforts
    Effectiveness Comes from Within
    Pursuing Efficiency and Effectiveness Together
    Setting the Standard for Quality
    A Model for the Effectiveness Transformation
    Effectiveness for Health Care: Doing It Right

    Tools for Efficiency and Effectiveness
    Least Common Denominator: Information Technology and Digital Transformation
    Data and Analytics
    e- and m-Health Technologies
    Telemedicine (Telehealth)
    Input Substitution
    The Performance Improvement Imperative
    Expert Consensus: Tools for Changing the Future

    Redirecting Reform: Strategic Recommendations
    Review of Reasons to Redirect Reform
    Policy Recommendation 1: Limit the American Health Sector to 17% of GDP
    Policy Recommendation 2: Require Performance Improvement for Federal Reimbursement
    Policy Recommendation 3: Develop a National Consensus on a Good Health Care System

    Epilogue: Organizational Success Factors for Efficiency and Effectiveness
    √ Standardization
    √ Flexibility
    √ Integration
    √ Alignment
    √ Leadership
    √ Accountability
    √ Creativity



    Dr. Jeffrey C. Bauer is an internationally recognized health futurist and medical economist. As an independent industry thought leader, he forecasts the evolution of health care and develops practical approaches to improving the medical sector of the American economy. He is widely known for his specific proposals to create an efficient and effective health care delivery system through multistakeholder partnerships and other initiatives focused in the private sector.

    Dr. Bauer has published more than 250 articles, books, web pages, and videos on health care delivery over the past 45 years. He speaks frequently to national and international audiences about key trends in health care, medical science, technology, information systems, reimbursement, public policy, health reform, and creative problem solving. Dr. Bauer is quoted often in the national press and writes regularly for professional journals that cover the business of health care. His latest book is Upgrading Leadership’s Crystal Ball: Five Reasons Why Forecasting Must Replace Predicting and How to Make the Strategic Change in Business and Public Policy (Taylor & Francis, Boca Raton, FL, 2014). Other recent books include Paradox and Imperatives in Health Care: How Efficiency, Effectiveness, and E-Transformation Can Conquer Waste and Optimize Quality (with Mark Hagland; Productivity Press, New York, 2008) and Statistical Analysis for Health Care Decision-Makers (CRC Press, Boca Raton, FL, 2009). His two previous books are Telemedicine and the Reinvention of Health Care: The Seventh Revolution in Medicine (with Marc Ringel; McGraw-Hill, New York, 1999) and Not What the Doctor Ordered (McGraw-Hill, New York, 1998).

    As a consultant, he has assisted hundreds of provider, purchaser, and payer organizations with strategic planning and performance improvement. He served as industry thought leader for the Superior Consultant Company and (after acquisition) as vice president for health care forecasting and strategy for ACS, a Xerox Company, from 1999 to 2010. His previous consulting firm, The Bauer Group, specialized in consumer-focused strategic planning and development of clinical affiliation agreements for multihospital networks from 1984 to 1992.

    In addition, Dr. Bauer has extensive academic experience. He was a full-time teacher and administrator at the University of Colorado Health Sciences Center in Denver from 1973 to 1984, where he held appointments as associate professor and as assistant chancellor for planning and program development. He also served concurrently for four years as health policy adviser to Colorado Governor Richard D. Lamm. From 1992 to 1998, Dr. Bauer was a visiting professor in administrative medicine at the Medical School of the University of Wisconsin–Madison, where he taught physician leaders how to evaluate research reports and other published studies. Prior to his career in health care, he worked on meteorology projects for the National Center for Atmospheric Research. He received his PhD in economics from the University of Colorado–Boulder.

    He graduated from Colorado College in Colorado Springs with a B.A. in economics and completed a certificate in political studies at the University of Paris (France). During his academic career, he was a Boettcher Scholar, a Ford Foundation Independent Scholar, a Fulbright Scholar (Switzerland), and a Kellogg Foundation National Fellow. He is an elected member of the Association of Managers of Innovation and the Institute of Medicine of Chicago and is an honorary Fellow in the American Academy of Nurse Practitioners. Dr. Bauer lives in Chicago, where he occasionally displays his paintings in local art galleries. He is an avid fan of music and member of the Governing Board of the Chicago Symphony Association.

    "This book displays my enduring optimism that visionary leaders who understand the paradox and imperatives are capable of delivering affordable, world-class health services to all Americans. After 45 years in the medical sector, I am an insider who cares deeply about improving our delivery system—a constructive contrarian excited by possibilities for a better future. To start moving us in this new direction, I propose private sector actions for providing care right all the time, as inexpensively as possible."
    —Jeffrey C. Bauer, Ph.D., Medical Economist and Health Futurist