Health care is a complex system of services that may affect people’s health and quality of life in many ways. In its most simple form, it involves a set of decisions that can be made by a physician to diagnose and treat illness, and a system of facilities that provide the necessary healthcare to people who need it. Health services are expensive, and the costs are rising rapidly. The United States is far ahead of other industrialized nations in its overall per capita spending on health care.
Many countries around the world have national health systems that include free or heavily subsidised healthcare, often through taxes that people pay. This is a different model than the current United States health insurance system that requires people to purchase private health insurance, often with a network of doctors who have signed agreements to work for a certain insurer. While both models have flaws, the key differences are how responsibilities for making quality decisions and delivering health care are allocated.
A key challenge for those responsible for operating a health program is determining what is the best way to assure that the system functions as intended. It’s not enough to focus on technical proficiency, because even in the hands of skilled professionals, poor outcomes can result from bad decisions or faulty care. There is also the question of whether there is a relationship between the services provided and health outcomes, and how to measure that link.
People want individual healthcare that maximizes their health potential and meets their health goals. Collectively, they want to ensure equitable access to essential health services, and a system that is affordable and manageable. Inevitably, there are trade-offs.
Some believe that healthcare is like any other consumer product: people should get what they can afford, and a free market provides the best mechanism to deliver that. Others believe that healthcare is a public good like highways, education and defense and that the government should allocate resources in a more consistent and equitable fashion than letting the marketplace decide.
Regardless of which view is taken, people’s desires and needs are diverse. Individuals want services that will cure disease and repair injury; they also desire information about the state of their health and prognosis. They have varied expectations about how much services cost and what they will actually accomplish, given the uncertainties about effectiveness of component healthcare services.
There are many barriers to obtaining quality healthcare, and they vary by population and region. Some are logistical: patients might struggle to get to appointments, and they might face long wait times to see providers. Other obstacles are more ideological, involving issues of fairness and efficiency. Some people think that fairness demands that everyone gets the same amount of health care (though how to define a “fair” allocation, and what about sicker people who need more), or that they should get less if their illnesses are partly their fault.
Another consideration is the obligation to consider future generations in the allocation of resources, which might imply greater funding for research and prevention programs. Finally, there is the ethical principle of respect for persons that imposes obligations on people to treat one another with dignity and respect, including when providing healthcare.