The health care industry encompasses all goods, services and devices related to the maintenance of good health or prevention of disease or injury. Health care can be purchased from private providers, employer-sponsored group health insurance plans, healthcare plans offered as part of a pension plan or through government programs like Medicare and Medicaid which are funded by tax dollars. The industry also includes the manufacture of medical devices and pharmaceutical products. The large, integrated healthcare systems which have evolved in recent decades are an important component of the current health care landscape.
Several different perspectives are held about how the health care system should be financed. One view is that health care is just another consumer product that some can afford and others can’t, and thus it should be paid for primarily by the consumers themselves via a free market. Another view is that health care is a right, and therefore the government has a moral obligation to provide it to everyone. A third view is that healthcare should be provided by the government as a public service and, as such, it should be financed with general taxes and allocated to people on the basis of need.
There is a growing concern about the impact that current trends in financing and delivery of health care are having on the quality of care. Some physicians believe that the accelerated growth of for-profit enterprises and the strong trend toward integrating finance and delivery are leading to conflicts within the physician-patient relationship and, in some cases, to the erosion of it.
Other issues that are being debated include the appropriate level of allocation of resources to various health care needs and the proper role of government. In many countries, the public and private sectors are combining to provide health services, with a growing proportion of funding coming from the private sector through premiums and out-of-pocket costs. However, there are also concerns that increasing amounts of healthcare spending are not leading to better health outcomes. In fact, OECD data suggests that for every extra $1,000 spent on healthcare in developed nations, life expectancy declines by 0.4 years.
There are also questions about the allocation of resources to future generations. Some people argue that the current generation has a moral obligation to ensure that adequate healthcare is available for future generations. This would mean increasing the amount of money allocated for research and prevention that could reduce the need for expensive treatment of chronic diseases and injuries.
Regardless of which financing method is used, there are some basic issues that need to be addressed. There is a need for transparency in pricing and in how information about quality of care is gathered and reported. There is also a need for a unifying factor to bring together the disparate elements of professionalism, malpractice, regulation, competition, cost and value purchasing. This unifying factor might be a focus on decision making and the need for meaningful information to support it.