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Challenge 1: Complexity

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The US healthcare system is inherently complex. Care delivery typically involves several semiautonomous individuals who also interact with others participating in the care delivery process. Theories from complexity and network science suggest that hospitals, health systems, emergency departments, and other care delivery units function as complex adaptive systems. This chapter will explore some of the characteristics of these systems and discuss how care delivery reflects these characteristics. Also contributing to the overall complexity is the nature of patient health and disease. The relationship between different organ systems, the connection between mental and physical health, and the multiple factors that influence health and illness all serve to increase complexity. These challenges make it harder to obtain accurate measurements and determine attribution when assessing value. When coupled with rapidly developing technological advances in patient care and health monitoring, it is likely that health and health care will continue to get more complex in the future.


  • Complex adaptive system
  • Medical technology
  • Reimbursement

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Fig. 2.1
Fig. 2.2


  1. 1.

    Also referred to as a complex adaptive network, or CAN.

  2. 2.

    Whether these payments are reimbursements for care provided and adjusted up or down depending on performance on quality metrics, or a capitated amount paid on a per-person basis depends on the context and situation.


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Solid, C.A. (2022). Challenge 1: Complexity. In: Practical Strategies to Assess Value in Health Care. Springer, Cham.

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