12. Constraints, parameters, and numbers.

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Such as subsidies, taxes, standards. Parameters are points of lowest leverage effects. Though they are the most clearly perceived among all leverages, they rarely change behaviors and therefore have little long-term effect. For example, climate parameters may not be changed easily (the amount of rain, the evapotranspiration rate, the temperature of the water), but they are the ones people think of first (they remember that in their youth, it was certainly raining more). These parameters are indeed very important. But even if changed (improvement of upper river stream to canalize incoming water), they will not change behavior much (the debit will probably not dramatically decrease).


If we think of systems as a set of interlinked interdependent bathtubs and plumbing, then we can imagine the “numbers” as the positions (how open or closed) of the faucets and drains. Some parameters set the flow rate in and out of individual bath tub. What are the parameters that we pay attention to in healthcare (Do any of these  distract us from more fundamental areas needing our attention?)

  1. MEDICAL SYSTEM parameters
    1. Productivity
    2. Wages
    3. Quality metrics
    4. Costs
    5. Referrals
  2. POPULATION parameters
    1. Insured / Uninsured
    2. Visits to ED
    3. Admissions and Readmissions
    4. Satisfaction
    5. Age, Sex, Health Status, ACEs
  3. PAYER parameters
    1. Medications
    2. Visits
    3. Tests
    4. Procedures