Health care is one of the largest and most important industries in any country. It consumes from 3 to 18 percent of GDP, employs large numbers of skilled and unskilled workers, and contributes greatly to local economy and a sense of community well being.
Individuals have a strong interest in health care that maximizes their health potential and that assures them equitable access to essential services. However, the effectiveness of component health services is uncertain and unexplained differences in use of services by different providers for apparently similar patients remain problematic (Vladenkock 1988).
Government involvement in health care is extensive, and it has led to regulations that are more intensive, intrusive, and complex than those in most other developed countries. The result is that health care in the United States has become a complex amalgam of public and private components.
Despite these regulatory efforts, many health care problems persist, including rapidly increasing costs and unexplained variations in the provision of services for seemingly similar patients. In addition, many people lack health insurance coverage, and those who have it find that they are just one illness or accident away from bankruptcy.
Some people do not receive recommended health care because they do not have a primary care provider, or because they cannot afford to pay for needed services. Others do not get adequate treatment because they are misdiagnosed or otherwise improperly treated by their doctors. Still others do not get needed care because they are indigent or otherwise excluded from the system. The cost of medical services is high, even in the best of times, and a fifth of the population was without health insurance in 2019 (CDC).
The 2023 State Scorecard ranked Massachusetts, Hawaii and New Hampshire at the top on 58 measures of health care access, quality, use of services, costs, health disparities, reproductive care and women’s health, and outcomes. The lowest-performing states were Oklahoma, West Virginia and Mississippi. Health care costs are increasing faster than most other goods and services, while life expectancy continues to decline.
There are a number of ways to improve the efficiency and equity of health care. An important step is to reduce its costs. Another is to improve the quality of service by focusing on informed decision making and moving beyond simplistic balance sheets that ignore cost issues. A third is to foster innovation in the delivery of health care. And finally, there must be an emphasis on accountability that involves all parties—individuals, insurers, employers, the government, and professional associations. Moreover, all those involved in the process must recognize that they cannot solve the problem of unexplained variations in health care alone. They need to work together to address the problems of professionalism, regulation, malpractice, and value purchasing. Only in this way will we succeed in achieving a system of health care that is worthy of the name.