Health care is the medical and public health services provided by professionals, organizations, or governments. It includes medical and surgical treatment, as well as preventive care and community services like vaccinations. Health care is delivered through hospitals, primary and specialty care physician practices, clinics, community health centers, home health agencies, and pharmacies. It also includes allied health care providers such as nurses, physical therapists, occupational therapists, speech therapists, psychologists, and dietitians. Health care is expensive and often confusing to consumers, especially those without health insurance. This article describes the major components of health care in the United States, as well as some key differences from other countries.
A person receives health care through a variety of mechanisms, including private insurance, the military or VA system, Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP). The most common way to access health care is through a personal doctor or medical office. Physicians usually charge a fee for their services, and patients can typically submit claims to an insurer or other third party for reimbursement of health care expenses. Many employers provide employees with health insurance as part of a compensation package, and individuals may purchase health insurance through an individual market or through group coverage offered by their employer or through the government-sponsored exchanges established under the Affordable Care Act.
While advances in pharmaceuticals and biologics have improved the lives of millions of people and extended life expectancy for many, these gains are outweighed by escalating costs. There is a need to focus more on prevention and public health programs, as well as to identify the factors that contribute to high-cost spending.
In 2002, health care spending in the United States accounted for 14.9 percent of GDP. Hospital services represented 31 percent of the total cost; professional services made up 22 percent; and drugs, supplies, and equipment accounted for 14 percent.
There is a growing concern about the quality of health care in the United States. Researchers have found that the country spends more on health care than other countries but has lower levels of quality, particularly in terms of mortality and other measures of public health. Physicians are often paid on a resource-based relative value scale that rewards the provision of services that have little impact on patient outcomes, and drug and device companies vigorously promote their products despite their high costs.
Some experts recommend adopting a different model of health care, such as the one used in Singapore, where patients pay more out-of-pocket and are encouraged to seek health services that deliver the most benefit per dollar spent. Others advocate implementing alternative payment models, such as bundling payments to providers or creating accountable care organizations, in which networks of providers assume contractual responsibility for providing a specific population with health care that meets specified quality targets. Still other experts argue that more transparency in pricing for health services could lead to healthier purchasing behavior among consumers. This would help keep costs down by encouraging consumers to seek out high-value services and to demand a lower price for ineffective ones.