The Break-Even Point: When Medical Advances Are Less Important Than Improving the Fidelity With Which They Are Delivered

The authors draw a sharp line between the return on investment in technological innovation versus investments in system improvement to ensure that people get timely appropriate care(authors refer to this as fidelity). Without a doubt, many in the public and policymaking arenas have come to equate high quality care with technology improvement, without paying much attention to the care systems on which the application of that technology rests. How do we help to move toward a more appropriate balanced investment? For starters, to the extent health care providers, researchers and others 'turn up the volume' on the importance and value of system functionality that supports appropriate, timely care, the message won't necessarily be lost on important stakeholders. And, as the authors note, public discouragement with health care may also help to catalyze fiscal policy realignment. In fact, some recent federal actions do acknowledge the importance of investing in related improvements and measuring progress against established indicators. Having said that, we nevertheless clearly have a long way to go. In addition to the dynamic so well articulated by the authors describing the fascination with technological breakthroughs and the related lack of adequate thought given to real impact and tradeoffs, another major challenge to moving this discussion forward is the fragmented health care and health policy world in which we live. Our current approaches to health care investment are too often based on slivers of targeted activity rather than more comprehesive assessment and phased-in actions. Instead, we need a 'systematic approach' to critically analyzing health care broadly, including the 'system' features that are essential to ensuring that care is timely and appropriate. Without the bigger picture in focus, tradeoffs that are made are hidden--except for the occasional article, like this one, that illuminates some of them.

Competing interests:   None declared