191 Copyright © 2012, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. Chapter 9 DOI: 10.4018/978-1-60960-872-9.ch009 Arjun Parasher Leonard M. Miller School of Medicine, USA Pascal J. Goldschmidt-Clermont Leonard M. Miller School of Medicine, USA James M. Tien University of Miami, USA Healthcare Delivery as a Service System: Barriers to Co-Production and Implications of Healthcare Reform ABSTRACT Both during and after the recent reform efforts, healthcare delivery has been identified as the key to transforming the U.S. healthcare system. In light of this background, we borrow from systems engineer- ing and business management to present the concept of service co-production as a new paradigm for healthcare delivery and, using the foresight afforded by this model, to systematically identify the bar- riers to healthcare delivery functioning as a service system. The service co-production model requires for patient, provider, insurer, administrator, and all the related healthcare individuals to collaborate at all stages – prevention, triage, diagnosis, treatment, and follow-up – of the healthcare delivery system in order to produce optimal health outcomes. Our analysis reveals that the barriers to co-production – the misalignment of financial and legal incentives, limited incorporation of collaborative point of care systems, and poor access to care – also serve as the source of many of the systemic failings of the U.S. healthcare system. The Patient Protection and Affordable Care Act takes steps to reduce these barriers, but leaves work to be done. Future research and policy reform is needed to enable effective and efficient co-production in the twenty-first century. With this review, we assess the state of service co-production in the U.S. healthcare system, and propose solutions for improvement.