The word health care is used in the United States both to refer to a specific service and to describe an entire system of public and private efforts to promote, maintain, or restore physical or mental well-being. It is sometimes hyphenated, as in “healthcare system,” but more often left unhyphenated.
Regardless of how it is referred to, all countries strive for a health care system that delivers on the general population’s legitimate expectations. Personally, most people want care that maximizes their potential to preserve or improve their health and well-being. Collectively, they want health care that is readily accessible and affordable.
To achieve these goals, nations employ a variety of strategies. Some have a centralized, national system funded by government, while others rely on private insurance. Still, most of these systems face similar challenges. They must balance the desire for patient autonomy against the need to control costs and ensure quality. Moreover, they must contend with the fact that medical errors and other unintended consequences of treatment—known as iatrogenesis—cause significant harms.
Despite these challenges, many health care experts believe that there are ways to move closer to the ideal of a health care system that delivers optimal health at a price the nation can afford. Some of these approaches include implementing external regulatory controls to ensure quality, encouraging competition between providers through consumer choice, and freeing patients from the administrative burdens associated with healthcare management.
Affordability and access to care are the two most critical dimensions of a healthy, functioning health care system. In our study of 11 countries, Norway and the Netherlands rank highest in these domains, while Germany and Canada lag behind (see How We Measured Performance).
Access includes measures of whether health care is available to all who need it and how accessible it is when they are ill. It also encompasses the ability to choose doctors and other clinicians and to be seen in a timely manner. In top-performing countries, workforce policy is geared to ensuring access, with physicians distributed geographically to match needs.
Affordability is a complex measurement of how much a person or family must pay to get the health care they need, including both direct out-of-pocket payments and indirect costs such as lost income. It is also influenced by the cost of insurance, which is in turn affected by how much people value the coverage and what benefits they expect to receive. To reduce the cost of health care, some governments limit benefits or require people to contribute a share of the premiums, either through employer-sponsored plans or individual policies purchased on the private market. Other governments provide their citizens with a basic benefit package and make the cost of additional services tax deductible. This approach can have negative effects on efficiency, but it may be more effective than attempting to limit benefits. It can also reduce the risk that people will forgo needed care because of the cost, which could lead to worse outcomes.