Health care is a complex set of activities and services that aim to preserve and restore human physical and mental well-being. It encompasses a broad range of interventions, from preventive and promotive to curative and palliative. Its delivery is facilitated by physicians, nurses and other allied health professionals. It is financed by individual and group health insurance plans, employer-sponsored benefits, and government programs. Health care is delivered in hospitals, private practice settings, clinics, community facilities, and homes. Often, the same patients receive a mix of services from multiple providers. As a result, there is great potential for fragmentation of care and lack of continuity. The growing presence of for-profit enterprise and aggressive marketing by providers to consumers and health insurers are seen as major barriers to providing continuity of care.
The question of how we should organize the delivery of health care has been a major political issue for decades. Some argue that the system should be market-oriented, while others believe that it should be publicly financed with premiums and copayments reflecting a fair allocation of health risks. There is a growing consensus that the delivery of health care should be based on principles of equity, efficiency, and effectiveness. The challenge is to find ways to provide access to quality health care for everyone at a reasonable cost.
A common view is that a well-functioning health care system should emphasize prevention, screening and early diagnosis to improve overall health. It should also focus on enhancing and empowering individuals and communities for greater self-care, and on addressing the upstream determinants of health and disease. It is important that these efforts be integrated with comprehensive primary health care (PHC) to ensure that people have the health outcomes they want and value.
Many countries have tried to achieve the goals of high-performing health systems. Norway, the Netherlands and Australia rank first, second, and third, respectively, in the Commonwealth Fund’s survey of health care quality and accessibility. The United States ranks last, despite spending far more per capita on health care.
One reason for the poor performance of American health care is that it fails to address the needs of lower-income individuals. Studies show that being without health insurance negatively affects subjective measures of health and life satisfaction, even for those with incomes above 200 percent of the federal poverty line.
It is argued that the United States could improve its performance by adopting some features of the Swiss and British systems, which are based on free-market principles with heavy doses of public funding. A key to success in these systems is that competition fosters good information flow and values personal choices and preferences.
Another issue is the extent to which we should take into account the needs of future generations in allocating resources for health care. Some suggest that health care should be treated like other public goods such as highways and education, which are shared by everyone. This implies that those who exist now owe a moral obligation to make sure there are enough clinicians trained, buildings built, and funds available to meet the needs of future generations.