Achieving Health Care Reform in the United States: Toward a Whole-System Understanding

The U.S. health care system faces serious problems of high cost, limited access, unequal treatment, and inadequate health protection. Though these problems have persisted for decades and various reforms have been attempted, the overall impact of reform efforts has been only modest. This paper examines potential types of reform and the history of reform efforts. Causalloop diagrams are presented which together comprise a theory to explain what created the set of problems that exist and why efforts at reform have largely failed. Different philosophical bases for reform and the need for an eclectic approach are discussed, and a sequential “bootstrapping” approach to comprehensive reform is outlined. The diagrams and discussion of this paper are intended as a starting point for further collaborative work on health care reform among system dynamics practitioners and health policy experts, leading to simulation modeling and further insights.