Health care involves a complex interaction between medical science, technological advances, and human psychology. Depending on how the topic is approached, it can be seen as a consumer product that some people can afford and others cannot, or as a public good like highways, education, or defense that governments should provide to all. It can also be seen as a sacred trust that requires ethical standards and rigorous monitoring to ensure that doctors are using the best practices and not harming patients. Whatever the perspective, it is clear that health care is different from most other products or services in that it can have a profound impact on people’s lives and well-being.
For many people, access to health care is a fundamental part of their quality of life and the ability to participate in their communities. Without it, they face the prospect of financial disaster should an illness or accident strike. Some people rely on their employers to provide them with health insurance, while others obtain it through private insurance providers. Still others seek assistance through government programs.
Regardless of how they gain access to it, most people want their health care professionals to have the latest in medical knowledge. Some may go to great lengths to ensure that happens, including seeking care in other countries or even paying for it themselves at very high costs. Others may eschew it altogether, either because they think the cost is too prohibitive or because their health conditions do not require it.
A common view is that a market-based system that values individual choice and supports competitive methods will lead to improvements in health care quality. This tenet assumes that consumers can effectively evaluate health care performance, which requires information to be available (whether from outside evaluators or through the clinician community itself). In practice, competition for market share tends to promote price competition rather than a focus on quality, and it is unclear whether the information flow is sufficiently strong to identify and punish outliers.
It is also important to remember that many factors influence the performance of health care systems. For example, the largely unregulated environment in which the United States operates has been found to be associated with lower-quality care than that of more highly regulated countries. This is because the unregulated environment does not have the mechanisms to limit medical technology that is based on expensive research, or to steer it toward technologies that are cost-effective.
In addition, a growing number of Americans are finding themselves uninsured. As of 1999, one out of six had no coverage at all. Despite the longest economic expansion in history, these numbers remain troubling. A better understanding of the consequences of current policies and health care financing arrangements can refocus policy attention on this longstanding problem. It can help us design more effective initiatives and better evaluate those that are already being implemented.