Health care is a unique industry in several ways: the product is ill-defined, the outcomes of care are often uncertain, large segments are dominated by nonprofit providers, and payments are made through third parties. Nonetheless, the various players in the health care system respond to incentives just as they would in any other industry.
The goal of health care should be to protect the lives and well being of people through preventive, diagnostic, therapeutic, and rehabilitative services to achieve optimal physical, mental, and emotional functioning (WHO, 2017). Physicians have a responsibility to provide safe, high-quality, patient centered, efficient, timely, and equitable care in keeping with principles of wise stewardship and medical science. Physicians must also strive to improve health outcomes to the extent possible, in keeping with best available scientific data and without violating patient autonomy or physician professional integrity.
The quality of health-care services delivered is influenced by many factors, including people’s individual characteristics and behaviors, their social circumstances, and the physical environment. People’s behaviors, such as smoking, lack of exercise, and unhealthy diets, can lead to conditions that require medical care. Some of these conditions are inherited, while others are caused by external factors such as pollution or occupational hazards.
Health-care utilization is influenced by the availability of affordable insurance and the degree to which people understand their health coverage and benefits. In the United States, most people get their insurance through their employers and the government offers subsidies for private marketplace plans. However, even with those subsidies, some people still cannot afford a plan. Many individuals report having trouble accessing health-care services because of the cost. Those who report having a regular source of care have better self-rated health and are less likely to be underinsured.
Individuals use a variety of strategies to pay for health-care services, including cash payments, copayments, deductibles, and insurance premiums. In addition, there are a number of innovative payment models being developed to address rising costs. One such model, referred to as “bundled payments,” involves grouping together the services that a typical person will need over a specific period of time and paying the provider a single fee for those services rather than paying each service separately.
When choosing a plan, consumers should look for a list of doctors and clinics in the plan’s network. Consumers should avoid any plan that doesn’t offer a wide enough range of in-network doctors in their area. In addition, those who have the option to choose their own plan should look for a “summary of benefits” and a provider directory online or ask their employer’s workplace benefits administrator for these documents. In most cases, a plan that includes more in-network doctors will have lower out-of-pocket costs and fewer required referrals to see specialists. A more comprehensive list of in-network options may be especially important for those who live in rural areas.