Health care is one of the largest and most important industries in any country, consuming anywhere from 3 to nearly 18 percent of national gross domestic product (GDP). It provides a vital service that enhances people’s health and well-being, contributes to economic development, and often creates jobs and contributes to the social fabric of communities.
The influence of health care on life and death is profound, but the quality of that care can vary considerably. Some countries have excellent systems that deliver high-quality care at low cost and are well integrated with other public services; others struggle to get the best value for money while providing safe, effective and equitable healthcare.
We are committed to learning from the experiences of other countries and to finding ways to improve the U.S. health system. The Commonwealth Fund studies the performance of health systems in other nations, seeks out policy and practice innovations and compares the U.S. to other high-income countries on the measures of effectiveness, efficiency and equity in health care.
Our definition of health care includes all aspects of the patient experience, from prevention and diagnosis to treatment, rehabilitation and palliative care. It also includes a broad range of related services, such as medical equipment and supplies and home health services. This broad scope reflects the fact that healthcare is an increasingly complex service delivered in multiple settings by a variety of providers, including physicians and nurses, therapists, pharmacists, psychologists, dentists and many other specialists.
The health care industry is complicated, with many financial and organizational challenges. For example, the way payments are made can affect how much a patient pays for a particular service. Copayments and insurance premiums are often paid through complex mechanisms involving coding and claim processing. Many hospitals have specialized departments to manage the billing and collections process. In addition, patients are frequently required to pay out-of-pocket costs upfront and then submit reimbursement claims to their insurers.
In the United States, most people get their healthcare through private health insurance provided by their employer or bought in the private marketplace. Some of this coverage is subsidized by the federal government through the Affordable Care Act (ACA) and Medicaid programs in states that chose to expand eligibility.
The ACA established a foundation model for national health systems, which are defined as groups of healthcare organizations (e.g., physician practices, hospitals, skilled nursing facilities) that are jointly owned or managed and serve a common geographic referral region. These systems must include a minimum of 1 general acute care hospital and 10 primary care physicians. The Foundation Model also requires that the health systems share information and best practices with one another. These standards are intended to improve efficiency and improve the overall quality of healthcare delivery by creating a more coordinated system of care. In some states, the foundation models are being implemented through partnerships between public and private organizations or with academic institutions. Eventually, all states are expected to implement the foundation model.