The term “health care” refers to all goods and services that support people’s physical, mental, and emotional well-being. It includes everything from primary care to hospitalizations, surgeries, laboratory tests, and medications. Health care can also include behavioral health services, community outreach and prevention efforts, and public and private insurance plans.
The world’s top performers in health care tend to have a highly integrated system with clear roles for each of these players, which can reduce fragmentation and keep costs down. These countries are also more likely to provide preventive services to their citizens and to use new technologies to deliver care efficiently, resulting in better outcomes and lower prices.
While there is no one-size-fits-all model for health care, all nations can learn from the experiences of others and develop policies and practices that may improve their own systems. This is why The Commonwealth Fund regularly conducts international comparisons of health care systems and seeks out policy and practice innovations from around the globe.
A common definition of health care is the efforts of trained professionals to maintain or restore human health through diagnosis and treatment. These efforts can be as simple as an annual checkup or a complex surgery. For most countries, the bulk of health care spending is on treatments rather than preventive health services. The major exception is for poorer countries, which must spend more on preventive care in order to achieve the same levels of medical progress as wealthier nations.
In the United States, health care is delivered by physician offices, hospitals, clinics, laboratories, imaging centers, and many other institutions and organizations. In addition to these providers, the health care landscape includes pharmaceutical companies, health insurance firms, group purchasing organizations, pharmacy benefit managers, and other entities. Most of these entities are not necessary in every interaction with a healthcare provider, but they can add up to significant cost and complexity.
Most Americans get their health insurance through their employers or a privately purchased individual plan. When deciding on coverage, consumers should consider whether it covers the types of care they most often need, how much out-of-pocket costs will be, and what restrictions might be in place, such as requirements to stay in-network or to receive drugs only through the manufacturer’s prescribing channel.
A quality health insurance plan should offer a clear and comprehensive summary of benefits, which includes all cost sharing and coverage details. In addition, the plan should include a list of in-network doctors and a link to a provider directory. Having this information can help consumers make wise choices about their health care options and minimize surprises when they need to access the system. It can also make them more informed consumers when negotiating with their providers about prices. If consumers are not sure which plan is right for them, they should ask their employer or health insurer to send them a copy of their summary of benefits. This will enable them to compare benefits and costs across different plans and choose the one that fits their unique needs and budget.