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Why We Can’t Wait: The Rocket Science of Health-Care Delivery


Jim Young Kim


Throughout history, our country’s great colleges and universities have answered the call to find solutions to our most pressing social problems. Desegregation, discrimination, legal and human rights, and the science of diseases such as cancer and AIDS are but a few examples. It is time for us to lead again in the next phase of health-care reform.

The new health-care reform law will allow us to take critical steps in addressing structural problems in our insurance and reimbursement systems but, unfortunately, there is little in the legislation that will help us work on the problem of how care is delivered to patients. We know that the problem of high-cost, ineffective, and even dangerous health-care delivery is a global problem, and institutions of higher education must play a central role in finding and disseminating solutions.
It is well known that the cost of the U.S. healthcare system, as a share of GDP, is the highest in the world, and yet, compared with other industrialized countries, our results are among the worst. The Dartmouth Atlas of Health Care has documented the enormous waste in our system and has shown that spending more money and performing more medical procedures do not equate to better outcomes for patients.
We cannot address the ever-increasing, unsustainable costs of health care without getting to the foundation of how care is provided. Nor can we achieve the social and moral goals we share—care that is safe, appropriate, effective, and high quality for every patient, in every community—without rethinking and redesigning delivery. Real improvements require a multidisciplinary approach that will bring the best minds to focus on the problem. Experts in management, systems thinking and engineering, sociology, anthropology, economics, medicine, health policy, and other fields must join together to fix the delivery system.
At Dartmouth, we have recently established a new Center for Health Care Delivery Science to put this approach into practice. The center brings together scholars and practitioners from our faculty of arts and sciences, the Thayer School of Engineering, the Tuck School of Business, Dartmouth Medical School, and our affiliated academic medical center to collaborate, innovate, implement, and educate around this next stage of reform.
The ambitious health legislation establishes an implicit covenant with the American people. The spirit of this covenant goes far beyond insurance. In exchange for new public and private investment in the health system, Americans expect access to effective, high-quality health care within a financially sustainable system. With a robust science of healthcare delivery, this goal can be achieved.

It is my profound hope that other colleges and universities will join with us in this work. If in five years Dartmouth remains the only Center for Health Care Delivery Science in the United States, we will have failed. My predecessor, John Sloan Dickey, famously said, “There is nothing wrong with the world that better human beings cannot fix.” We who are privileged to send those better human beings into the world every year have not only the ability to lead, but also the moral responsibility to come together once again in search of answers to one of this generation’s most pressing problems.
Jim Yong Kim is president of Dartmouth College.