Health care is a complex, interconnected system with a profound influence on society and individuals. As a result, decisions about it involve competing values and overlapping responsibilities, making it difficult to determine what should happen and who is responsible. Despite high technical proficiency and good intentions, poor outcomes often occur and even the best decisions and efforts can have unintended consequences. Moreover, health services are not directly related to the well-being of people and their ability to function in their daily lives; other factors that influence the quality of life and health outcomes, such as lifestyle, social support, economic status, and public policy, exert much more important influences (President’s Commission, 1983).
In the United States, health care is fragmented across thousands of hospitals, systems, payers, and providers. This creates opportunities for waste, inefficiency, and coordination problems that can lead to medical errors, which kill 98,000 Americans each year. These and other problems are made worse by resource constraints and conflicting demands for access to care.
Several different theories can be used to explain why some people do not have adequate health care and how it can be improved. The most prevalent one is the utilitarian approach, which suggests that healthcare works best if it is delivered in the most efficient manner possible. People who take this view believe that those who have a right to healthcare should go to the free market to obtain it and those who do not have a right should use a distribution mechanism provided by government.
Another theory focuses on the role of incentives. Those who receive health care in fee-for-service settings may feel that their incomes depend on how well they perform on certain measures, such as reducing costs or improving patient satisfaction. This can lead to conflicts of interest and the temptation to choose measures that are favored by third-party payers, including Medicare. Similarly, those who provide health care may be influenced by the expectations of their employers or patients.
A third theory involves separating the effects of health care from other factors that might cause or improve health outcomes. It is likely that all of these factors interact in a complex way, and it is not clear how much credit should be given for longer life expectancy or better health. Moreover, the specific contributions of individual and population factors will vary over time and space.
A final theory is that the quality of healthcare has a symbolic aspect that goes beyond its technical and practical elements. People want to trust and be treated with respect in their interactions with health care professionals and enjoy the mysterious, awesome aspects of curing and healing. This may also play an important role in determining whether people value healthcare and are willing to pay for it.