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      Is U.S. health care an appropriate system? A strategic perspective from systems science

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      1 ,
      Health Research Policy and Systems
      BioMed Central

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          Abstract

          Context

          Systems science provides organizational principles supported by biologic findings that can be applied to any organization; any incongruence indicates an incomplete or an already failing system. U.S. health care is commonly referred to as a system that consumes an ever- increasing percentage of the gross domestic product and delivers seemingly diminishing value.

          Objective

          To perform a comparative study of U.S. health care with the principles of systems science and, if feasible, propose solutions.

          Design

          General systems theory provides the theoretical foundation for this observational research.

          Main Outcome Measures

          A degree of compliance of U.S. health care with systems principles and its space-time functional location within the dynamic systems model.

          Results of comparative analysis

          U.S. health care is an incomplete system further threatened by the fact that it functions in the zone of chaos within the dynamic systems model.

          Conclusion

          Complying with systems science principles and the congruence of pertinent cycles, U.S. health care would likely dramatically improve its value creation for all of society as well as its resiliency and long-term sustainability.

          Immediate corrective steps could be taken: Prioritize and incentivize health over care; restore fiscal soundness by combining health and life insurance for the benefit of the insured and the payer; rebalance horizontal/providers and vertical/government hierarchies.

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          Most cited references21

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          Combined impact of lifestyle factors on mortality: prospective cohort study in US women

          Objective To evaluate the impact of combinations of lifestyle factors on mortality in middle aged women. Design Prospective cohort study. Setting Nurses’ health study, United States. Participants 77 782 women aged 34 to 59 years and free from cardiovascular disease and cancer in 1980. Main outcome measure Relative risk of mortality during 24 years of follow-up in relation to five lifestyle factors (cigarette smoking, being overweight, taking little moderate to vigorous physical activity, no light to moderate alcohol intake, and low diet quality score). Results 8882 deaths were documented, including 1790 from cardiovascular disease and 4527 from cancer. Each lifestyle factor independently and significantly predicted mortality. Relative risks for five compared with zero lifestyle risk factors were 3.26 (95% confidence interval 2.45 to 4.34) for cancer mortality, 8.17 (4.96 to 13.47) for cardiovascular mortality, and 4.31 (3.51 to 5.31) for all cause mortality. A total of 28% (25% to 31%) of deaths during follow-up could be attributed to smoking and 55% (47% to 62%) to the combination of smoking, being overweight, lack of physical activity, and a low diet quality. Additionally considering alcohol intake did not substantially change this estimate. Conclusions These results indicate that adherence to lifestyle guidelines is associated with markedly lower mortality in middle aged women. Both efforts to eradicate cigarette smoking and those to stimulate regular physical activity and a healthy diet should be intensified.
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            General System Theory

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              Requisite Variety and Its Implications for the Control of Complex Systems

              W. ASHBY (1991)
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                Author and article information

                Journal
                Health Res Policy Syst
                Health Research Policy and Systems
                BioMed Central
                1478-4505
                2009
                2 January 2009
                : 7
                : 1
                Affiliations
                [1 ]Health Research International, 333 Westbrook Rd, St Helena Island, SC 29920, USA
                Article
                1478-4505-7-1
                10.1186/1478-4505-7-1
                2629469
                19121210
                1087f2e9-1c59-4d4c-9836-228481fe2111
                Copyright © 2009 Janecka; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 8 July 2008
                : 2 January 2009
                Categories
                Research

                Health & Social care
                Health & Social care

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