Health care covers a broad range of functions, from prevention to diagnosis and treatment to long-term recovery. It includes both physical and mental healthcare, and is a global industry requiring a steady financing mechanism, a trained and adequately paid workforce, access to reliable information, and well-maintained health facilities.
In some countries, health systems are financed by the government through tax payments. Others have a more “free-market” approach, where the healthcare sector is largely private but covered by public insurance. A country’s healthcare system is made up of providers, patients, payers, research trials, programs, organizations, institutions, related businesses, laws and regulations, and policies.
The World Health Organization defines a good health system as one that offers comprehensive and effective healthcare for all the people. It requires a financing mechanism, a well-trained and adequately paid workforce, access to reliable information, reliable data to base decisions on, and well-maintained health facilities that deliver quality medicines and technologies.
Some nations have a more comprehensive system than others, and the Commonwealth Fund studies those systems and seeks out policy and practice innovations that work. But no nation has the perfect health system, and all need to learn from the ways in which other nations have achieved optimal performance.
Health systems also differ in how they address the care needs of vulnerable populations. In some countries, the poorest and most vulnerable have less access to care than they should and are disproportionately represented in the health workforce and hospital emergency rooms. Other systems provide more services for the least well off and most chronically ill, such as Medicare and Medicaid in the United States.
Despite its size and prominence, the United States is a poor performer overall in health care. As a high-income country, it has much to learn from other nations that have managed to achieve high performance and low costs.
Universal coverage is a key element of a healthy and sustainable health system. This ensures that all people have access to the health care they need at a price they can afford.
Many studies have shown that the uninsured are less likely to receive needed health care than those with insurance, and they receive fewer preventive services and have lower rates of chronic disease management. In addition, the uninsured are more likely to delay needed care until their condition becomes intolerable.
Some uninsured people, however, find other means to obtain the care they need. This can include seeking care from a non-insurance provider, paying for it out of pocket, or seeking care from a nonprofit or highly subsidized provider.
In addition, health insurance can be difficult to understand, and may have coverage restrictions that limit your ability to use the services you need. For example, some plans require that you use their network of providers, which limits your options and may result in higher out-of-pocket expenses.
Other factors, such as linguistic and cultural differences or lack of transportation to care, also contribute to health inequities. The Commonwealth Fund is studying these factors and identifying opportunities to improve the United States’ health system.