Outra vez Mongo na Medicina: os cuidados de Saúde

O encerramento das maternidades, a concentração das unidades de saúde, são movimentações que podem fazer sentido no Excel.
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Contudo, na vida real, tenho dúvidas, quer quanto à poupança, quer quanto à eficácia.
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É tão... século XX.
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Quanto maior uma organização, maior a complexidade, maior a ineficiência porque vai ser muitas coisas em simultâneo, maior a desumanidade.
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Recomendo a leitura do ponto "1. Wrong question", Christiansen descreve bem a evolução da procura e a estagnação da oferta.
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O ponto "4. Wrong conclusions about scaling", reflecte tão bem o meu sentimento:

"Now it is true that in the mid-20^th Century, economies of scale seemed overwhelming. Big oligopolies were in charge of the marketplace and could dictate terms. But in the 21^st Century, with globalization and the fundamental shift in power from seller to buyer, agility has become steadily more important and the clumsiness of big-firm bureaucracy has steadily become a bigger problem. To stay in business, firms have to delight their customers, not just deliver a product, and bureaucracy never delighted anyone: it wasn’t intended to.
It’s also true is that in the 21^st Century, the general hospital is a doomed animal. These large, complex, confused institutions spend much of their effort in inappropriate or ineffective action or overhead activities. As Christensen and Hwang point out, they will not survive.
But neither will chains of general hospitals survive. Simply stapling large inefficient organizations together into chains doesn’t make them more efficient. The larger they get, the more the bureaucracy and the hierarchy are likely to get in the way. Chains of hospitals will survive only if they become different, for instance, by differentiating and separating the main jobs-to-be-done that Christensen and Hwang have defined. (Moi ici: Ver ponto 1) Because patients will have freedom of choice and good information as to what’s available, the market will steadily eliminate hospitals with mediocre performance.
There will be a future for a hospital than can offer, for instance, the highest quality knee replacement, as in Gawande’s example. But there is no future for either a hospital or a chain of hospitals offering mediocre and expensive care for a wide variety of very different health problems, including structured, unstructured and chronic problems: the hospital will end up doing them all expensively and badly.
Nor is it obvious that the winners of the new health game will be hospitals at all. A facility that does only cataract surgery or only chemotherapy or only diabetes treatment may actually be quite small. It doesn’t need to be housed in some grandiose marble-lined palace like so many 20^th Century general hospitals. It will not have to suffer interruptions from a larger bureaucracy or from the demands of competing health needs. Because it is totally focused on a single function, it can become very good and very efficient at doing it. Because it is the best at what it does, it can attract patients from all around, not just from the neighborhood. These small highly-specialized barracuda-like organizations will be a big part of the future of health care, not just hospitals."

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Trecho retirado de "How Not To Fix US Health Care: Copy The Cheesecake Factory"