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Can health care outcomes be proxy of value?

Value is not intrinsic to anything or anyone. Value only arises in a system as its emergence, based on self-organizing relationships; it’s a transient state. You can meaningfully measure outcomes in mechanical/linear systems but you encounter great difficulties if you attempt the same in biologic/non-linear systems.

The generation of value is in a constant flux within any complex adaptive system, being it the human body or the larger societal health care system. When you attempt to measure health care or even one person’s health by focusing on a certain limited number of parameters, outcome indicators, the conclusions that you may arrive at are unlikely representative of the true state that you set out to measure; the innumerable system’s relationships constantly generate the elusive ever-changing positive or negative emergence/value.

It seems that value of a biologic system is not really measurable in conventional terms as it represents the system’s emergence where the whole is greater than the sum of its parts. Some components of value can be measured but that will not give us an estimate of system’s generated value. In a linear/mechanical system the number and the relationships of components are known and fixed hence measuring each is feasible and here the whole does exactly equal the sum of its parts. Biologic systems, however, are non-linear where the number of components and their inter-relationships, for all practical purposes, is infinite, not truly knowable/controllable. The value creation in a biologic system comes out of its gestalt.

For further discussion, please see links below:

Janecka IP: Is the U.S. Health Care an Appropriate System? A strategic perspective from systems science. Health Research Policy and Systems 2009, 7:1

            (Highly Accessed) http://www.health-policy-systems.com/content/7/1/1

Janecka IP: Cancer control through principles of systems science, complexity, and chaos theory: A model. Int J Med Sci 2007; 4:164-173. http://www.medsci.org/v04p0164.htm