Paradox and Imperatives in Health Care: Redirecting Reform for Efficiency and Effectiveness, Revised Edition, 2nd Edition (Hardback) book cover

Paradox and Imperatives in Health Care

Redirecting Reform for Efficiency and Effectiveness, Revised Edition, 2nd Edition

By Jeffrey C. Bauer

Productivity Press

159 pages | 1 B/W Illus.

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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


"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

Table of Contents

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


About the Author

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.

Subject Categories

BISAC Subject Codes/Headings:
BUSINESS & ECONOMICS / Quality Control
BUSINESS & ECONOMICS / Industries / Service Industries
MEDICAL / Administration