Health care, the efforts to maintain or restore one’s physical and mental well-being by trained professionals, is a unique industry. It differs from other industries in that the product is ill-defined, the outcome of care is uncertain, the health industry is highly fragmented, large segments are dominated by nonprofit providers, and payments are made by third parties such as public and private insurers. However, even with these differences, the health industry is still an industry like any other, and the various players respond to incentives just as in other industries.
In addition to a desire to improve their own health, individuals want a health system that is effective in preserving their lives and that assures equitable access to the essentials of life. Individuals also want a physician-patient healing relationship free of interference from third parties. Individuals in the United States also expect a health system that is efficient and whose costs are not unreasonably high. These competing demands provide a context for rapid health care spending growth and unexplained variations in use of services by different physicians for seemingly similar patients.
A societal value that is not always explicitly stated is the belief that everyone should have the opportunity to live as long as possible. This societal value, which is implicit in the definition of health, drives a significant portion of spending on health care. The challenge is to maximize quality of life at a cost the nation can afford.
The current debate over health policy is focused on how best to accomplish this goal. The major policy options are: government single-payer, employer-sponsored health insurance, consumer-driven health plans, and a marketplace of private and public health insurance. Each option has its advantages and disadvantages.
Some individuals obtain the health care they need without having health insurance by paying for it out of pocket or through the assistance of family and friends. Others obtain health care by taking advantage of publicly financed programs such as community health centers and hospital emergency departments. Many others, however, avoid obtaining needed health care because they do not have financial resources, have difficulty finding providers who will accept their insurance, or face nonfinancial barriers such as a lack of transportation, illiteracy, or language and cultural limitations.
A major goal of the health care industry is to prevent diseases and injuries by providing health screenings, vaccinations, and education. The ability to do so depends in part on the state of medical and scientific knowledge. This state is dynamic, however, and changes over time. Therefore, it is important to define the scope of health care to include not only treatment of illness and injury but also prevention and promotion of health.