Healthcare Systems

Healthcare Systems

Healthcare Systems

   The article Why is Healthcare Regulation so Complex? by Dr. Robert I. Field argues that the complexity of healthcare regulation is caused by the conflicting interests that created the healthcare system. However, a compromise between the different opposing interests ensures that there is balance, thereby creating efficiency despite the intricacy of the healthcare system. The article states that stakeholders involved in the healthcare system support external regulatory oversight to manage the healthcare system. However, there is a lack of uniformity and consistency in the system because of the multiplicity of the programs and regulatory bodies involved in healthcare regulation. All government levels, including the local, state, and federal levels and various private organizations are involved in the regulatory oversight of the system. However, they do not always operate with the coordination and efficiency that would lead to the protection of the interests of citizens. Thus, the complexity in the healthcare system does not ultimately result in benefits to the patient or client.

    Opposing interests have been changing the healthcare system for about 150 years. According to Field (2008), the root of the opposing interests is the federalist American government structure is the fact that it separates federal and state powers, leading to a tug of war on what roles and responsibilities should fall to particular institutions. Therefore, the tension in the healthcare system is an inherent part of the federalist system. The states are concerned with the regulatory oversight of the insurance companies, hospitals and physicians. However, Field (2008) reports that the coordination of the state activities occurs at the federal government level. The federal government uses the Centers for Disease Control and Prevention (CDC) to coordinate the state and local healthcare systems. The CDC has intervened in cases such as the outbreak fears, such as the anthrax attacks on news agencies and various government officials in 2001. In such cases, there is a need for coordination between different state agencies because of the complexity of the issue. Disease outbreaks can be difficult to manage, particularly infectious ailments such as Ebola and anthrax. Therefore, the CDC and the federal government in general have a large role to play in ensuring that such outbreaks are treated before they cause significant damage. However, for individual patients in the healthcare system, the federal government’s role in the coordination of the state and local agencies has little utility. Patient concerns might be majorly the acquisition of quality healthcare and fair insurance coverage.

    The entry of private regulators at the beginning of the 20th century created an additional layer of complexity but the private regulators have an important role to play in the regulatory oversight of physicians to protect patients from malpractice. For example, various organizations attached to the American Medical Association are involved in licensure examinations and certification, which is a crucial process for patients. In addition, Field (2008) writes that Medicare programs use the certifications to ensure that patients get quality physicians. On the other hand, Field (2008) reports that the multiplicity of oversight bodies can provide bureaucracies that can be hard to navigate. The researcher cites two examples of the problems that organizations and people seeking regulatory guidance face. The first example is the path to medicine practice. An overwhelming number of regulatory and oversight bodies administer and regulate the path, making it difficult for physicians to navigate the healthcare system and become certified doctors. In the second example, the path to marketing new drugs can be complicated and tiresome for the pharmaceutical industry. The pharmaceutical company has to acquire approach from various organizations, including the federal Food and Drug Administration (FDA). The hurdle in the two examples arises from the healthcare system’s complexity. While the regulatory environment contains many requirements to ensure that the drugs that enter the market are safe and sold fairly, there are various examples that show loopholes in regulatory oversight of pharmaceutical companies.

    Examples from the pharmaceutical industry reveal that patients can be victimized through the insurance systems because of failures in regulatory oversight. The infamous price gouging in Turing pharmaceuticals is an example that even with the complex and multilayered regulatory oversight structure, pharmaceutical companies can charge exorbitant prices on their drugs, thereby leading to an increase in healthcare expenditure and a corresponding increase in insurance premiums. A biopharmaceutical company can acquire significant market dominance and influence other companies to charge higher prices for their drugs (Jain, Hasija & Netessine, 2018). Turing generated high profits by acquiring small manufacturers and increasing the prices of key drugs such as cancer drugs. Companies with similar drugs also increased their prices to match Turing pharmaceuticals in what Jain, Hasija and Netessine (2018) call the Shkreli effect. In one instance, Turing increased the price of Daraprim, a drug used in the treatment of cystoisosporiasis and toxoplasmosis. Consequently, Turing caused a subsequent increase of Cosmogen by about $737. Currently in the U.S., companies sell Cosmogen at $1,400 compared to between $20 and $30 in other countries. The huge price discrepancy between the U.S. and other countries is an example of the regulatory oversight failures most likely caused by the complexity of the healthcare system. Regulators did not notice the price-gouging trend until the consequences of price gouging became visibly apparent. Therefore, there was a systemic-wide failure in healthcare regulation of insurance and biopharmaceutical companies.       

    Complexity could have created the systemic issues that make healthcare expenditure in the U.S. very high. Field (2008) argues that complexity has improved the healthcare system in the U.S. since patients are confident of the professional competence of physicians because of licensure regulatory oversight by private companies. Also, Field (2008) argues that the administration and regulation of the research and development into new drugs by organizations such as the National Institute of Health has increased patient confidence in the healthcare system. However, there is an increasing interest in alternative healthcare programs, which promise natural healing remedies. The rise of the alternative health movement in the U.S. suggests that patients are preferring to seek healthcare outside the traditional healthcare systems. Empirical evidence from Brainard and Hunter (2015) shows that complexity-informed health interventions do not work. The researchers studied 29 articles describing 22 interventions. They found that it was difficult to establish a clear connection between cause and effect in complex adaptive systems. Therefore, diagnosing a problem in complex systems becomes difficult. Inability to detect cause and effect in complex systems could be the reason why the price-gouging scandal described in Jain, Hasija and Netessine’s (2018) article is difficult to deal with.

    The analysis of Field’s article has shown that while the division of responsibilities between the state, local and federal agencies can improve efficiency in some areas such as disease outbreak control, complexity has not significantly improved patient and client outcomes. The rise of alternative health movements and the price gouging in the U.S. pharmaceutical industry demonstrate the problems caused by the complexity of the U.S. healthcare system. An inability to deal with the rising healthcare costs shows that complexity does not necessarily lead to a better healthcare system.


Brainard, J., & Hunter, P. R. (2015). Do complexity-informed health interventions work? A

scoping review. Implementation Science, 11(1), 127.

Fields, R.I. (2008). Why is Healthcare Regulation so Complex. Retrieved from

Jain, N., Hasija, S. and Netessine, S. (2018). Preventing Price Gouging in the Pharmaceutical

Industry: A Comprehensive Policy Approach. Retrieved from https://publicpolicy.wharton.upenn.edu/live/news/2390-preventing-price-gouging-in-the-pharmaceutical


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