During the Map the System Competition at Johns Hopkins University, Chloe Kwak, Britney Pullin, Maham Fatima Humair, and Cristina Munoz presented a systems analysis of the American healthcare reimbursement structure that challenged many common assumptions about inequity in medicine. Their presentation, Return on Care, explored a difficult but necessary question: who is the healthcare reimbursement system truly designed to serve?
The team argued that many of the inequities present in American healthcare are not accidental side effects of a failing system, but rather the predictable outcomes of a structure designed to prioritize procedures, productivity, and profit over preventive and holistic care. Their analysis highlighted the gendered consequences of these incentives, explaining how women are disproportionately disadvantaged both as healthcare workers — whose labor is often undervalued — and as patients, whose symptoms and healthcare needs are frequently dismissed, delayed, or undertreated. Rather than framing these issues as isolated failures, the team mapped what they described as a “clinical silence loop,” reinforced by longstanding mental models that continue to shape policy, reimbursement structures, and clinical practice.
One of the most impactful aspects of the presentation was the team’s willingness to directly challenge the assumption that the healthcare system is simply “broken.” Britney Pullin articulated this clearly when she stated, “The system is not broken, it is functioning as designed.” That distinction fundamentally shifts the conversation. If a system is broken, solutions focus on repair. But if inequitable outcomes are the result of intentional structures and incentives, then meaningful change requires redesigning the system itself. Britney further emphasized that “if you want to make impactful change, you have to first have the ability to change your mind, and challenge others to do so too.” That emphasis on shifting underlying mental models aligned strongly with the systems-thinking framework at the center of the competition.
Chloe Kwak expanded on this perspective by focusing on the policy architecture sustaining these inequities. Her analysis underscored that awareness alone is insufficient if the structures producing harm remain intact. As she explained, “To address inequities, we must examine and change the structures, not just educate individuals.” The team consistently reinforced the idea that many healthcare interventions fail because they stop at improving individual understanding rather than addressing the financial and institutional incentives embedded within the system itself.
Cristina Munoz brought an especially innovative analytical lens to the project through the use of Dynamic Mode Decomposition (DMD) and Koopman operator–based methodologies. These approaches are designed to identify dominant behavioral patterns within nonlinear systems and can help reveal “stable system modes” that persist even when policies change. By applying these methods to healthcare reimbursement structures, the team sought to better understand which inequities remain deeply embedded despite reform efforts. As they noted in their report, the goal is to create “robust structural transformation through data-driven methodology traceable over time, ideally within state and federal analytic dashboards. If dominant system modes remain unchanged, improvements decay when incentives revert.” Their use of advanced systems modeling strengthened the project’s argument that lasting change requires altering the underlying incentive structures, not simply implementing temporary reforms.
The context of presenting this work at Johns Hopkins University — an institution deeply connected to the history and evolution of American medicine — was not lost on the team. Rather than softening their critique, they directly acknowledged the tension between institutional prestige and systemic inequity. That willingness to critically engage with the structures surrounding them added further credibility and depth to their presentation.
The team’s proposed next step — collaborating with policymakers, insurers, and healthcare organizations to pilot reimbursement reforms that incentivize gender-equitable care — reflected the scale and seriousness of the issue they mapped. Their project made clear that healthcare inequity is not a niche or isolated concern, but a structural consequence of how value is defined within the healthcare system itself. Through their systems analysis, the team demonstrated that addressing these inequities requires more than awareness campaigns or individual behavior change; it requires redesigning the structures that determine what, and who, healthcare systems prioritize.
Special thanks to Mahima Singh for sharing insights that helped shape this article.
