Health care, broadly defined, includes services that are related to physical and mental health. It covers preventive, diagnostic, therapeutic, rehabilitative and maintenance services. It also includes support services such as education, counseling and training. The goal is to promote and restore the health of individuals.
In our view, a fundamental challenge facing the world’s health systems is to provide people with health care that satisfies their legitimate expectations. This requires ensuring that the health care provided is safe, effective and timely. It should also be people-centred, responding to the needs and preferences of individual patients. Finally, it should be efficient, maximizing the benefit of available resources and avoiding waste.
While a range of countries have strengths and weaknesses in each of these areas, no country is at the top or bottom of the rankings across all dimensions. Even the highest-ranked nation, Australia, performs worse in some areas than it does in others, for example on access and care process.
The U.S. is an outlier, not only in its overall performance but also in the share of GDP it spends on health care. This is a result of many factors, but one critical factor is the prevalence of for-profit enterprises. The growing trend toward the integration of financing and delivery of health services has serious implications for quality. Prospective payment systems and capitated programs, for example, can introduce financial incentives that threaten the balance between patient safety and cost control.
For-profit companies also tend to emphasize profit over other considerations such as patient satisfaction and the effectiveness of care. This can lead to overtreatment or use of more expensive technologies than are necessary. This can be a particular problem in relation to palliative care, which is often delivered to dying patients. Such treatments often have unintended side effects that can be fatal, a phenomenon known as iatrogenic death.
There is a need to develop and implement innovative approaches to financing and delivery of health care. Some of these new approaches, such as telehealth and remote monitoring, may help to improve access, reduce costs and increase the efficiency of the health system. Efforts to increase the compensation of primary care clinicians and to invest in their training may also be important.
The health care industry is unique from other industries in a number of ways, including its complexity, its focus on human beings rather than on machines and materials, the presence of many nonprofit providers, and the involvement of public and private insurers. These differences, however, should not obscure the fact that health care is a commodity industry like any other and that its various players respond to incentives just as they would in any other market. These incentives include those arising from profit-seeking activities and from the pressures of a competitive marketplace. Health care also faces additional pressures that are specific to its societal context, such as the need to meet community-wide expectations for health outcomes and to provide health insurance for all.