I have long believed there to be more in common between the states of K-12 education and healthcare in the US than might commonly be thought. (Bear with me here, as I’ll bring this back to the simulation focus of the blog at the end.) Let’s look at the similarities:
In K-12 education, the US spends… (1)
- …more on a per-pupil basis than all but one other nation, Switzerland, within the OECD (Organisation for Economic Co-operation and Development),
- …53 percent more on a per-pupil basis than the OECD average, and,
- …42 percent more on a per-pupil basis than the OECD nations with the best combined math and science scores (Finland).
And yet despite all this spending on education, the US scores… (2)
- …14th out of 34 OECD nations in reading,
- …24th out of 34 OECD nations and “statistically significantly below the OECD average” in mathematics, and,
- …16th out of 34 OECD nations in science.
(In the first group of three items above, spending comparisons are based on cumulative per-student expenditures between 6 and 15 years of age as of 2008. In the second group of three items, scores are based on the 2009 Programme for International Student Assessment, or PISA.)
In healthcare, the US spends… (3)
- …more in total on health as a percentage of GDP than any other nation within the OECD,
- …46 percent more in total on health as a percentage of GDP than the next highest spending nation within the OECD, Netherlands,
- …85 percent more in total on health as a percentage of GDP than the OECD average, and,
- …151 percent more on a per-capita purchasing power parity basis than the OECD average.
And yet despite all this spending on healthcare, the US… (3, 4, 5)
- …has the fourth highest infant mortality rate in the OECD (ahead of only Chile, Turkey, and Mexico) and an infant mortality rate 41 percent higher than the OECD average and 177 percent higher than that of the best-scoring OECD nation, Iceland,
- …ranks below the OECD average and 29th out of 39 OECD nations in healthy adjusted life expectancy (HALE) at birth, and,
- …has the seventh- or eighth-highest rate of mortality amenable to healthcare (defined as “premature deaths that should not occur in the presence of effective and timely care”) of 31 OECD nations surveyed, depending on the methodology used.
As the authors of a 2010 paper from The New England Journal of Medicine put it, “It is hard to ignore that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy… Why do we spend so much to get so little?” (6)
(On the subject of infant mortality, to translate the percentages into concrete terms, in 2010, the year to which the data above applies, the US had 24,548 infant deaths. (7) If our infant mortality rate were the same as the OECD average, we would have suffered 17,409 infant deaths, or 7,139 fewer than actually occurred. If our infant mortality rate were the same as the best-scoring OECD nation, Iceland, we would have suffered 8,829 infant deaths, or 15,719 fewer.)
When I look at a market where the spending and results are so out of whack, what I see is a highly disruptable market — that is, a market which is vulnerable to change based on radically better approaches. As the Wikipedia entry for “disruptive innovation” puts it, “A disruptive innovation is an innovation that helps create a new market and value network, and eventually goes on to disrupt an existing market and value network (over a few years or decades), displacing an earlier technology. The term is used in business and technology literature to describe innovations that improve a product or service in ways that the market does not expect, typically first by designing for a different set of consumers in the new market and later by lowering prices in the existing market.” (8)
If there are two markets that are in desperate need of disruptive innovation, they must be education and healthcare. And I believe that simulation could be the key to disruption in both markets.
If there are two markets that are in need of disruptive innovation, they must be education and healthcare.
In education, simulation gives us the opportunity to deliver students the benefits of experiential learning in almost any subject imaginable. Using simulations, students can explore topics from history to mathematics, from language to chemistry, all in simulated environments that enable them not only to try different strategies but even — given the proper tools — to change the underlying assumptions of the simulation.
In healthcare, simulation gives us the opportunity to improve performance at a systemic level by modeling healthcare systems and virtually prototyping changes to them. Using simulations, clinicians, clinical engineers, and other healthcare professionals can gain, as I co-wrote in a 2010 paper, “the ability to essentially develop the equivalents of flight simulators, systems integration laboratories, and intelligent cockpits for clinical environments”. (9)
I think the chances are excellent that we will make use of simulation to improve and even remake our education and healthcare systems. To me, the question is not “if”, but rather “when” and “how”.
References after the break.
1. de Rugy V. K-12 spending per student in the OECD. Blog entry on the Mercatus Center at George Mason University website. December 20, 2010. Full text.
2. PISA 2009 results: executive summary. Organisation for Economic Co-operation and Development. 2010. Full text (PDF).
3. OECD health data 2012-frequently requested data. Organisation for Economic Co-operation and Development. 2012. Spreadsheet (Excel).
5. OECD life expectancy at birth and healthy adjusted life expectancy at birth. Organisation for Economic Co-operation and Development. Spreadsheet (Excel).
7. Murphy SL, Xu J, Kochanek KD. Deaths: preliminary data for 2010. National Vital Statistics Reports. National Vital Statistics System, National Center for Health Statistics, Centers for Disease Control and Prevention, US Department of Health and Human Services. 2012;60(4). Full text (PDF).
8. Disruptive innovation. Wikipedia authors. 2012. Full text.
9. Boosman F, Szczerba RJ. Simulated clinical environments and virtual system-of-systems engineering for health care. Interservice/Industry Training, Simulation and Education Conference (I/ITSEC) 2010. Abstract. Full text (PDF).