Health care is a complex issue that has a profound effect on people’s lives. Unlike most other social goods, the value of health care is difficult to quantify in terms of benefits such as improved health outcomes and greater quality of life. Because of its importance, society invests heavily in health insurance through personal expenditures and forgone wages and through tax policy. The ultimate ends of this investment are improved health outcomes and a healthier population. The achievement of these ends requires the development of comprehensive and integrated systems of health services that will improve health outcomes for all.
The current health care system is characterized by conflicting forces that make it a highly inefficient and costly enterprise. These include the strong trends toward integration of financing and delivery, for-profit enterprises in the service industry, and the growth of competitive marketing among physicians, hospitals, and other providers. These developments often lead to unanticipated and unexplained variations in use of medical services for apparently similar patients (IOM, 1986a).
These factors are exacerbated by the fact that many of the functions of health care are not related to curing or maintaining good health. Rather, they have other valued outcomes, such as assessment and certification of health status, prognostication, and helping individuals to cope with illness-related problems (Fuchs, 1988). These “paracurative” services often do not result in direct improvement in health, but they can make the difference between a good or bad outcome.
A central element of the health care system is primary care, which can prevent or detect disease in its early stages. This can reduce the need for more expensive treatments and hospitalizations and allow more resources to be directed toward other aspects of health care. Primary care also includes health education to promote healthy lifestyles and the availability of affordable medications, which can prevent diseases from developing in the first place.
The United States ranks near the bottom on most measures of health care performance, but it performs well on some. This is partly a function of the size of the population and the relative importance of health care in the economy, which tends to make countries that spend more on health care more efficient in their use of resources. However, the country’s high spending is also related to its low ranking on measures of access and the quality of care process.
A key problem is the lack of transparency and accountability in the provision of health care. The availability of information is critical, but it must be accompanied by an understanding that health care is different from other goods and services. This approach helps to bridge the conflicts between professionalism, regulation, competition, malpractice, and value purchasing, and it encourages a focus on decision making as opposed to the mere measurement of cost and quality. In addition, it promotes strategies for using available information to improve quality. This is essential for the long-term sustainability of our health care system.