The challenge is to provide health care that people need and want, and which will meet their legitimate expectations (medical or otherwise). It also involves addressing the complex issues linked to its financing, continuity, and proper management. This involves balancing the many different interests and values, and identifying which ones should be given priority. This will require integrating the various knowledge elements: scientific, clinical, technical, interpersonal, manual and cognitive.
Health care is an important aspect of the lives of most citizens and their families. It affects their health status and wellbeing, quality of life and happiness, and economic opportunities and stability. The impact of healthcare on these attributes is variable and sometimes not well understood.
Its importance makes it a major focus of public concern, which is reflected in the large amounts of money spent on it by governments and private individuals. It is a highly complex sector that has been the subject of extensive research, often with controversial results.
The United States has a health care system that is among the most regulated industries in the world and yet it continues to experience rapid increases in health care costs, unexplained variations in the use of services by providers for seemingly similar patients, and unsatisfactory outcomes for some populations. The causes are not fully known, but the resulting pressures have created serious concerns about the quality and efficiency of this sector.
It is a difficult issue to manage because of the ambiguous and often competing values associated with it. For example, the desire for greater safety should be balanced with the goal of minimizing harm to patients by limiting access to expensive but potentially lifesaving treatments. The fact that iatrogenic deaths, or errors made by doctors, are one of the leading causes of death in the US, highlights the need for more attention to the prevention and management of medical error (RAND 2001).
Health policy makers have sought to control costs and improve the quality of healthcare by implementing a wide range of initiatives. They have promoted competition and market-like arrangements, imposed external controls, promoted cost awareness, provided financial incentives for physicians and hospitals to reduce costs, and enacted legislation to limit malpractice liability. Despite these efforts, the overall quality of health care in the United States remains poorer than that in other industrialized countries.
Ultimately, the most effective and sustainable solution is to change the way the industry functions. This requires moving away from a system that emphasizes profit and focusing on the value of health. This is a profound challenge, but one that can be met with the cooperation of patients, policy makers, and providers. It will also help to ensure that the information available about health care is useful in supporting decision making. This will also help to disentangle the different strands of debate around professionalism, regulation, competition, and malpractice, and move towards a common language for understanding and discussing the problems of health care. This will help to build a consensus that can be used to make sound policies and achieve lasting improvements.