Really interesting article in The Atlantic about efforts to reform the medical information system. One general observation is that the potential of information systems to permit flexible corporate/government operation are often defeated by corporate culture
So representatives of Athenahealth approached the major health insurance companies and proposed a new payment model: Instead of paying for professional services, the insurers would pay a global fee for all care — hospital care, physician care, lab care — so that if Athenahealth could keep the mother healthy, lower the rate of complications and therefore lower costs, it would be able to more than cover the cost of the additional upfront preventive care, benefit financially and in the process drive down the total amount of money the insurers had to pay out. A win-win for all. “The insurers said, ‘Look, we completely agree with your math,'” Park said. “‘We agree with the five-year study that shows this model will work, but we can’t rewire our systems to pay you differently from everyone else. We have to keep paying you on a per-service basis, even though we completely believe that this lowers cost for higher value.’
Think about how much the insurance companies have invested in information technology and about how rigid and fragile the result.