Complicated and Complex Systems: What Would Successful Reform of Medicare Look Like?

A discussion paper written for the Commission on the Future of Health Care in Canada (The Romanow Commission), 2002.

In this paper we argue that health care systems are complex, and that repairing them is a complex problem. Most attempts to intervene in Medicare (and in many other health care systems) treat them as if they were merely complicated. We demonstrate this failure of understanding by tracing the deterioration of Medicare through a series of complicated interventions to its present destabilized state. We identify the tensions that seem to represent intractable problems in the Canadian and other systems that elicit strong responses from warring ideologies and professions. We argue that many of these dilemmas can be dissolved if the system is viewed as complex.