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Column: Yes, Health Care Can Benefit From Business

Hanover

Your Feb. 5 editorial, “A Science and an Art; Pondering Health Care Delivery,” expressed reservations about the application of business ideas to health care in general, and in Dartmouth’s new Master of Health Care Delivery Science program in particular.

We understand some skepticism. In fact, when faculty from the Geisel School of Medicine first came to Tuck to work on the program, they had reservations, too. But those reservations disappeared as Tuck and Geisel faculty saw how much they could learn from one another.

Perhaps the source of those reservations is the word “business,” as in “Tuck School of Business.” That is unfortunate, for what Tuck really teaches are principles of management, organization and markets. Anyone who thinks that the health care system cannot benefit from a close examination of its management and organization practices, and that some beneficial changes could be made in that regard ... well, we respectfully disagree. And, yes, knowledge of markets is important to the delivery of health care, too. If the new insurance exchanges are not markets, then what are they? Might it be possible to use the knowledge of consumer behavior possessed by the business school faculty to better design these exchanges (and Medicare Advantage and Part D exchanges, too)?

The editorial suggests the connection to business will ensure that lower costs win out over patients’ interests, but we assure you that the importance of patients’ preferences is a hallmark of the program. Ethics is also infused throughout the course of study — not as a stand-alone course, but integrated throughout. If we did not have ethics and concern for patients in the program, our student-partners would likely revolt. These students are truly amazing in their commitment to patient care and their desire to improving the system. Much of our optimism about the future of health care comes from them.

The editorial argues that health care organizations have constraints limiting what they can do. Yes, they do — but so do all organizations. Our Tuck colleagues in operations management, decision science, organization design and economics know a bit about managing subject to constraints. There is no reason for health care to reinvent this wheel. Indeed, much of the Master of Health Care Delivery Science program deals with the specific issue of how to meet an organization’s mission by delivering better health care ... subject to the never-ending constraint of resource limits.

A weakness of academia is our tendency to put expertise and knowledge into separate silos, with interchange among those silos being rare. With its health care delivery science program, Dartmouth succeeded in breaking down those barriers. Faculty from very disparate yet complementary disciplines now work together, with the truly noble goal of improving health. The program is not perfect; faculty, staff and students continue to work to improve it. But instead of searching for vague reservations about this kind of progress, we believe it should be held out as a model for change.

Professors Bob Hansen and Eric Wadsworth are faculty directors of the Master of Health Care Delivery Science Program at Dartmouth College.