At the academic facility near me alone, the amount of money (measured in doctor-nurse-hours, ambulance costs, and other wastes of time) wasted in operations excesses is estimated to be around $100MM.

And that is one regional academic system with 5 hospitals.

From an academic perspective—it’s not a hard problem. Route patients to the nearest clinical facility that matches their requirements. Match resources at that local facility to the appropriate level of care. But this fails to take into account the fragmentation caused by administrative responsibility.

Hospitals are non-profits. But we can use managerial language to translate terms into ops speak. Hospital admin (managers) administrate (manage) exclusive regions of hospital systems. Their value added is determined by surplus (pnl) which is attributed to the region they administrate. This attribution of pnl causes turf wars, which creates misaligned incentives for managers.

So we see issues where patients are routed across cities or counties based on their RVU value. That is an incentive problem.