The Triple Aim Program with Special Reference to Economics, Culture and Education

The Triple Aim was articulated in a Health Affairs paper by Berwick, Nolan and Whittington in 2008. It provided a conceptual underpinning for the Affordable Care Act calling for improved health outcomes, better satisfaction and lower per capita costs. While most health economists have emphasized moral hazard, information asymmetries, tax distortions, public goods and other market problems for the inefficiency of the health sector, the Triple Aim is premised on a tragedy of the commons argument. Lack of coordination in healthcare calls for government intervention to unitize resource use much as is done in oil extraction or for fisheries. Triple Aim related policies do hold promise for improving efficiency in production. But it, and especially the Affordable Care Act, are arguably not well positioned to systematically address allocative efficiency, the identification and prioritization of the most cost-effective and worthwhile uses of scarce resources. The United States has a political problem with this and we are making insufficient progress determining what is not worth paying for. This study provides a theoretical backdrop to the Affordable Care Act and explores the strengths and weakness of various policy measures. It also emphasizes the importance of culture in transforming the health sector. Cultural and education change is needed and expected among physicians, managers, patients and insurance beneficiaries. These changes will impact undergraduate and graduate health related education. The case of graduate healthcare management is explored with a focus on the shift back to business schools and the rise of clinical education for the management arena