As much as I agree with medico concerns over increasing levels of administrative costs, it doesn’t follow that there needs to be less organisational management in health delivery.
Scratch most hospital specialists and you find a visceral dislike of administrators – not as individuals, but as a functional class. If you’ve ever experienced some of the absurd service effects of administrative fiat, you’d see the point. But the disdain spreads to include organisational administration in general.
Medical service delivery is firmly rooted in a model from pre-industrial cottage industries. My medico friends won’t like me saying it, but medicine is ripe for industrialisation, 150 years too late. Arnold Kling:
The traditional model of medical delivery, in which the doctor is trained, respected, and compensated as an independent craftsman, is anachronistic. When a patient has multiple ailments, there is no longer a simple doctor-patient or doctor-patient-specialist relationship. Instead, there are multiple specialists who have an impact on the patient, each with a set of interdependencies and difficult coordination issues that increase exponentially with the number of ailments involved.
Patients with multiple diagnoses require someone who can organize the efforts of multiple medical professionals. It is not unreasonable to imagine that delivering health care effectively, particularly for complex patients, could require a corporate model of organization.
However, recent posts by Kling (here and here) and Atul Gawande (surgeon and writer) highlight that medico thinking on economics, consumer focus and management tends to the naive, with Gawande an example. I do have a lot of time for Gawande, ever since reading his Complications, especially since he highlights how some surgical procedures have been industrialised in India. But Kling is right.
Basically, doctors tend to folk economics that privileges and trusts individual agents (medicos) and is suspicious of systems that produce emergent order (structured organisations or consumer-driven markets). I have written similarly in discussing the Left’s tendency to actor-based conspiracy.
Kling links to a fantastic piece from Pascal Boyer. This is one of my new favourite blog sites [my emphasis]:
Finally, humans may be motivated to place their trust in processes that are (or at least seem to be) driven by agents rather than impersonal factors. This may be why there is a strong correlation between being scared of markets and being in favour of state interventions in the economy.
One of the most widespread political assumptions in modern industrial societies is that “the government should do something about x“, where x can be any social or economic problem.
Why do people trust the state? The state (in people’s intuitions, not in actual fact) has all the trappings of an agent. It is supposed to have knowledge, memories, intentions, strategies, etc.
Now it may be that people are vastly more comfortable trusting an agent to provide help or impose sanctions, than they would trust an impersonal, distributed and largely invisible process. That would be mostly a question of intuitive psychology (highly salient in our reasonings about social processes) versus population thinking (highly unintuitive, difficult to acquire and engage in without sustained effort).