Department of

Center for

Institutional and Organizational Innovation in Healthcare

Theories and Research on Institutional and Organizational Innovation Designed to Reduce Health Care Costs, Mortality, and Inequality

The growing deficits of the federal and state governments and especially in entitlement programs such as health care are generating a major social issue of how to provide quality health care at low cost to the poor, the working and the middle classes. This area of research like many policy arenas is dominated by an individualistic bias as characterized by the biological model of disease and most public health interventions. In both, the concept of social class is ignored as an important determinant. Only recently has the idea of the social determinants of illness appeared as an important concept in the study of health care delivery systems.

Despite the statements of various politicians that the U.S. has the best health care system in the world by the measures of health care inequality, mortality, and cost, it is much less effective than most of those in Europe. This has been true for several decades and is only becoming worse with the continued cuts in health care.

Despite the focus on health care, this new program continues the traditional interests of the Center for Innovation in both research and innovation. This shift in sectors means that we are concerned with how to measure innovation in medical research and innovative changes in the way in which health care is delivered so that it can reduce:

  • Health care inequality
  • Mortality
  • Health care costs

In these instances, the focus is not so much on innovative products or processes except for the work on the evaluation of medical research (see below) but on macro institutional change and in particular finding new kinds of interventions either at the community or national level.

One of the projects in this new program, which has been funded by the National Science Foundation, attempts to measure technical progress, an important kind of innovation, in clinical medical research with a system of metrics that distinguishes between prevention, screening and diagnosis/prognosis, treatment and post-treatment. Rather than focus on specific tools and techniques, the intent is to evaluate the clinical research program in its capacity to reduce health care costs and mortality. This project examines six morbidities: melanoma cancer, breast cancer, colorectal cancer, Alzheimer’s, frailty, and falls. Presently a book is being written on the results of this research.

Another project involves examing the factors that impact on the responses to feedbacks of information about the relative failure of villages to use malaria nets and to spray to reduce mortality in India. In developing countries, the current technology has been to use LQAS sampling techniques combined with concrete indicators to measure the effectiveness of various interventions to reduce disease and mortality. The first objective of this new project is to explain the differences between villages and between districts within the state of Orissa, India, an area that has the highest rates of malaria in India. The second objective of the project is develop experiments for testing whether quality work circles composed of villagers and of district public health officers can solve problems that are preventing the reduction in mortality as a consequence of malaria. Theorectically, the project would contribute the literature on organizational learning and explaining why organizations under certain circumstances do not learn. This project is under the direction of School of Tropical Medicine, University of Liverpool, U.K., which has received World Bank funds to fight malaria.

Updated 12 December 2016