If health care was deconstructed back to first principles all that would remain would be a patient and a physician.  Reconstruction would then involve adding components that enhance the value of the service provided from the physician to the patient.  There are so many people and layers now.  Health care has become incredibly complex but there is no clear evidence that this complexity translates into better care.  Maybe just another great example of a Rube Goldberg machine.  Could it be that there are people and their processes in this system that just add expense with no significant return on care delivery, quality improvement or cost savings?  There has always been a tendency to make things bigger but not necessarily better.  How much waste is present in the administrative suites?  There are personnel hired whose job on paper is related to making care better or more cost-effective.  They never come in contact with a patient.  An objective person would assume that this requires a close, collegial working relationship with the physicians delivering that care.  Is this occurring?  Can the physicians in the system attest that certain non-patient contact personnel actually enhance care?

The Institute of Medicine (IOM) has estimated that as much as 25% of the excess cost in the health care system can be attributed to excess administrative costs.  This amounts to $190 billion dollars.  Another $130 billion of excess cost is from inefficiently delivered services.  These inefficiently services are occurring in the era of managed corporate medicine.  Every player in the system needs to contribute to the mission of making health care better and affordable.  This includes providers, patients, payers and those in health care administration.

The return on investment of everyone who collects a paycheck from a health care system should be assessed.  Special attention should be focused on those who never come in contact with a  patient.  It is likely that the return in this group is especially low and great cost savings, without compromising care, could be obtained by eliminating or at least reducing these positions.  To assure that the process is objective a committee composed of many disciplines could be assembled.  Those who have no patient contact would be given a certain amount of time to research and prepare a presentation.  They would then present to the committee.  Each non-patient contact employee would have to present evidence that justifies their existence in the system.  Is there an evidence based argument that their position improves quality or decreases cost?  Some have minions of staff and resources.  Is it all necessary?  If there is an evidence based benefit to the position?  Could it be done more cost-effectively?

The delivery of health care from a physician to a patient, as well the administration of that health care, must be evidence based and simplified.  It’s the only pathway to quality and efficiency.