Improving Access to and Quality of Health Care

Health care is a unique good in that its consumption dramatically affects people’s health. It also differs from most other goods in that its effects are largely beyond the control of the consumer. As such, it is difficult to make distinctions between public and private health care; both have important influences on the overall quality of our society’s health.

Our system of health care provides for the diagnosis, treatment and prevention of disease and injury through a combination of services. These include laboratory tests such as the common blood count, urinalysis and microbiology; imaging services such as radiology (CT scans and ultrasound) and pathology (tissue examination); and medications including over-the-counter drugs and prescription medicines. In addition to promoting and maintaining the health of individuals, the system provides for research into disease processes and interventions to prevent or cure them.

In the United States, health-related expenditures account for more than a quarter of national gross domestic product and are growing rapidly. Despite these high levels of spending, many Americans experience difficulty in obtaining the appropriate and timely health care they need. For example, racial and ethnic minorities are less likely to have a usual source of medical care than whites, and adults with low family incomes are more likely to delay or not receive needed health care due to cost.

These difficulties arise in part because the provision of health care depends on the allocation of resources among competing individuals and agencies that have different priorities and values. Those values are often driven by the fact that health problems tend to affect certain groups more than others, such as the elderly, infants and racial and ethnic minorities. Furthermore, the symbolic aspect of health care – its role as an expression of mutual empathy and caring – adds to the challenge of providing high quality care that is consistent with current scientific and medical knowledge.

A key to improving access and quality is the provision of affordable health insurance coverage that includes a physician-based relationship with a primary care provider, preventive and screening services, outpatient prescription drugs, and specialty mental and emotional health care. It is also essential that the providers of health care provide patients with adequate information to help them understand and evaluate their options and decide what services are most appropriate for them.

The goal of the health care system should be to improve the health and well-being of everyone. To do so, it must be people-centred – taking into account individual preferences, needs and values – and efficient – maximizing the benefit of available resources and avoiding waste. Health care systems that achieve these goals have the potential to meet the challenges of a rapidly aging population, increasing rates of chronic disease and an escalating cost. In evaluating the performance of different countries, a unifying factor is their level of achievement in meeting these objectives. For example, France and Australia spend much more than the United States but perform comparably with it on many measures.

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