Is healthcare simply too complex an issue to be accurately modeled and solved? A 300 year old problem in physics may give us a clue.
The Three Body Problem has vexed physicists for hundreds of years. What is the Three Body Problem? Describing it is pretty simple. Solving it is something else.
In Newtonian physics, when just two bodies interact with each other gravitationally, let’s say just the Moon and Earth, their effect on each other has closed-form solutions that allow us to accurately predict the consequences of their interactions. In other words, if there were just the Moon(B) and Earth(A), we could easily model the effect they are going to have on each other at different points in time of their orbits.
So what does that have to do with healthcare? Well, if there were just Patients (the Moon) and Providers (the Earth), then over time we might be able to predict the effect they have on each other at different points in time, given potential changes in their behavior. But that’s not the way things work. There is a third “body,” the Payor for healthcare services, be that an insurance company or the government or the Patient.
Back to physics for a moment. The Three Body Problem occurs when we add a third orbital body with a gravitational force to the previous two (The Moon and the Earth), let’s say the third body is Mars. Adding just this one extra body prevents us for accurately gauging the effect they will now have on each other at different times in their orbit. There is no closed form solution to this. Simply by adding one extra body, the complexity introduced is impossible to solve. You can estimate a solution, but not solve it. This is true for Moon-Earth-Mars, or Sun-Moon-Mars, or Sun-Jupiter-Earth, etc.
In healthcare we now have three general bodies. The Patient, the Provider, and the Payor. Each has it’s own “gravitational pull” in terms of its effect on the other. The Patient “pulls” the Provider in one way, the Provider pulls the Payor, the Payor pulls the Patient, and so on. In general the motions (orbits) of these three bodies are unpredictable and ever changing, therefore so is their effect on each other.
If there is a change in the orbit of the Payor (let’s say Medicare changes a reimbursement schedule) the effect that will have on the other two bodies, Patient and Provider, under this analogy of physics, cannot be predicted.
For example, right now in the US, because of increased longevity and a lower birthrate, Patients are skewing older. This affects the Provider in terms of the services it has to offer, as then the Payor who now probably has to reimburse more, which then comes back eventually to affect the Patient.
Or, one can look at Google-Apple-WalMart-Amazon entering healthcare changing the trajectory of the Provider “orbit.”
All three bodies in healthcare, Patient-Provider-Payor, are constantly changing and having different pulls on the other. Things get really interesting to think about when 2 bodies collide in their orbits.
What does all this odd Newtonian math mean for healthcare? I think two things, 1) it might seem that combining two of the bodies, say Provider and Payor would simplify things by reducing the problem to a more predictable two-body problem, or, 2) the system is so complex and unpredictable that the most we can do is estimate the Patient-Provider-Payor Three Body Problem as best we can, and live with the complexity.