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Understanding health system reform – a complex adaptive systems perspective


  • Joachim P. Sturmberg MBBS DORACOG MFM PhD FRACGP,

    Corresponding author
    1. Associate Professor of General Practice, Monash University, Wamberal, New South Wales, Australia and The Newcastle University, Newcastle upon Tyne, UK
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    1. Associate Professor of General Practice, Sydney University, Sydney, New South Wales, Australia
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  • Carmel M. Martin MBBS PhD FRACGP FAFPHM

    1. Associate Professor of General Practice, Northern Ontario Clinical School, Sudbury, ON, Canada
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A/Prof. Joachim P. Sturmberg, Monash University, PO Box 3010, Wamberal, NSW 2260, Australia, E-mail:


Background  Everyone wants a sustainable well-functioning health system. However, this notion has different meaning to policy makers and funders compared to clinicians and patients. The former perceive public policy and economic constraints, the latter clinical or patient-centred strategies as the means to achieving a desired outcome.

Design  Theoretical development and critical analysis of a complex health system model.

Results and conclusions  We introduce the concept of the health care vortex as a metaphor by which to understand the complex adaptive nature of health systems, and the degree to which their behaviour is predetermined by their ‘shared values’ or attractors. We contrast the likely functions and outcomes of a health system with a people-centred attractor and one with a financial attractor. This analysis suggests a shift in the system's attractor is fundamental to progress health reform thinking.