According to Wikipedia, the etymology of the word, system, draws from the Latin “systēma” and “is a set of interacting or interdependent entities forming and integrated whole.” Systems are supposed to have similar features, “share common characteristics: structure, behavior, interconnectivity.”
The word, problem, has Latin, Greek, French origins from the word “problema,” and can be defined as “a difficult question proposed for solution.”
Can you imagine for a moment a “healthcare system” that actually meets these goals, measures up to this lofty definition? A place where we can presume care is somehow structured, interconnected, and has consistent behavior over time. A system where people understand the services available to them, how to access those services, and how to get the assistance they need in both an equitable and efficient manner. Let’s consider our own United States system for a moment with all of its entities and moveable parts: patients, providers, insurance companies, Medicare, COBRA, the uninsured, the underinsured, pharmaceuticals, biotechnical companies and so on. Try explaining to someone how the US healthcare system will assist or intervene on behalf of a middle aged professor newly diagnosed with a terminally ill disease; or a one month old baby who shows up to the emergency room with cough and high fever and whose mother’s job offers no health benefits. Even for those of us studying healthcare, systems, and policies; explaining how people are really taken care of is a difficult feat at best. There are many entry and exit points, different types of care or access to services based on status, knowledge, and variable interaction with system components which can all lead to drastically different outcomes. If we broaden our horizons to include developing countries such as those in sub-Saharan Africa or rural India where many people do not have the ability to obtain the basics, a fresh usable water supply, characterizing healthcare as having “structure, behavior, interconnectivity,” becomes even more absurd.
Perhaps we should rename this week’s discussion, “Introduction to health problems.” Because if we stop for a moment to reflect, ponder, analyze what we are saying by framing present day healthcare as a “system” the word simply may not meet our needs.