Complexity, Healthcare Systems and the Aporias of Healthcare Reform

Abstract

Paradoxically, “complexity” in health care systems has spurred both an application of complexity theory to health care organizations and a greater assertion of health care’s essentially political nature. This “increasingly stark dialectic between technical complexity and democratic expectation” ( Fierlbeck, Health Care in Canada: A Citizens’ Guide to Policy: 319) in the health field is part of what lies behind Frank Fischer’s Deweyan call in Democracy & Expertise for more “deliberative forms of interactive inquiry” and promotion of “practical knowledge that brings technical findings together with the political values and social assumptions to which they relate” (2009:6-7). This paper examines the applicability of complexity theory in health care organizations, and reviews such preliminary assessments that are contained in David Kernick’s empirical survey Complexity And Healthcare Organization (2004), Sturmberg and Martin’s, Handbook of Systems and Complexity in Health, (2013) . The paper then draws lessons for health care reform, with due attention to common themes as well as disagreements between analysts and theorists of health care complexity. One firm conclusion is that complexity theory is a valuable antidote to economic analysis and rational policy models the value of which is greatest when applied to relationships characterized by high predictability and linearity.