THE CHOICE between expanding health coverage and controlling healthcare costs is a false choice based on a false assumption: that resources committed to healthcare are used efficiently and effectively. The mistaken notion makes budgeting the key decision and masks a much better alternative. There is ample evidence that better care could be provided to more people at lower cost if care delivery were organized in a more sophisticated fashion.

In this extremely pertinent article, two major professional, Steven J. Spear from MIT and Donald M. Berwick from the Institute for Healthcare Improvement (Cambridge) explains that the health care system in the States, are obsolete - badly delivered and extremely costly for the system itself as well as for patients.

Medical sciences has tremendously improved in curing many diseases that only 10 years ago were still terminal.  But care delivery, and all associated management procedures (information, payment, hospital management etc) have not followed up.  Medicare announced recently that it will not continue to pay hospitals that do not tackle the problem of hospital-acquired intections in order to force them to change.

 "Alternatives to this absurd way of delivering cares already exist and have proven efficient.

Pioneers have reduced rates of hospital-acquired infections, falls, medication errors, and other complications - symptoms of fragmentation - by 90 percent and more, saving thousands of lives and hundreds of millions of dollars"

"Indeed, given the costs and waste in the healthcare status quo, redesign may be our only sustainable route to justice and financial solvency"

But, care delivery, information, and payment systems have not kept pace with the science. Professionals are still organized in silos, despite the pressing need to integrate