Abstract
Universal healthcare is usually measured through two questions: can people obtain the care they need, and can they afford it without financial hardship? Both matter. Neither tells us whether care actually reached the patient.
A person may hold a health card. The treatment may be covered. The ambulance, hospital, specialist and payer may each follow their own rules correctly. Yet the patient may still wait too long, arrive at a hospital that cannot treat them, or be lost between institutions.
This paper examines that gap through Decision Engineering™. It follows a person suffering a heart attack along the Decision Integrity Chain™—Purpose, Strategy, Intent, Rules, Judgment, Decision, Outcome and Feedback—and across the hand-offs that national statistics do not show: dispatch, transport, admission, records, clinical judgment, transfer and payment.
Failures can occur within any part of the system. But they often become harder to see, and more damaging, at the joins between them.
The paper proposes measuring the patient’s journey, not only the system: who accepted the case, how long each hand-off took, whether the record was available when a decision had to be made, what happened when the normal route failed, whether care arrived in time and whether the institution learned from what happened.
It also sets out a minimum decision record, using information that ambulance, admission, clinical, transfer and payment systems already hold. It distinguishes ownership, responsibility and accountability at every hand-off.
Coverage creates the promise. Decision integrity determines whether that promise reaches the patient.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Recommended Citation
Aggarwal, Deepak, "A Health Card Is Not Healthcare Why coverage does not always become care and how institutions can close the gap", Technical Disclosure Commons, ()
https://www.tdcommons.org/dpubs_series/11695