Bernard J. Healey


After reading this chapter you should be able to

• Describe the major problems found in the U.S. health care delivery system.

• Describe the need for reform of the present system of health care delivery in the United States.

• Discuss how health care services are financed in the United States.

• Explain the advantages of a focus on health outcomes rather than activities in the health care delivery system.

• Demonstrate the value of preventing disease rather than mostly attempting to cure disease.

What has happened to the health care delivery system in the United States, once considered the best system anywhere? This is a complicated question, and the answer you will hear depends on the biases of the group you are talking to. Physicians blame insurance providers, insurance providers blame employers, employees fault government regulation, and the consumers of health services blame everyone. This book is intended to help you better understand all of the important sectors of the U.S. health care system while developing an appreciation for all that needs to be done to improve health outcomes at a price those paying for health care can afford.

The health care delivery system in the United States is in a crisis situation that threatens its long-term survival. At the same time, this crisis offers tremendous opportunities for positive changes that will lead to a better system of care for all. The U.S. health care delivery system costs more than the system of any other industrialized country and yet delivers far fewer positive health outcomes to its population. Several indices of health care in America, such as infant mortality, fall below the results found in other industrialized countries, despite our extensive use of the newest and most expensive technology (Budrys, 2012).

According to Fuchs (1998) the major problems found in the U.S. health care system involve costs, access, and health levels and outcomes. There is also a serious problem with the quality of the health services received by many Americans. The cost of health care delivery has continued to rise for the last several years and was a leading reason why Congress recently passed the health care reform legislation titled the Patient Protection and Affordable Care Act of 2010 (ACA). The ACA is a federal statute designed

to increase the availability of health care coverage to most Americans and to improve the quality of that care. This new legislation attempts to solve the access problem for the millions of Americans who are without health insurance, and it should cause the number of uninsured people in the United States to drop dramatically in 2014. Unfortunately, this new legislation pays far less attention to health levels and outcomes, or wellness, in the U.S. population. We are currently dealing with an epidemic of chronic diseases, and these diseases and their complications are responsible for 80 percent of current health care costs.


Protection and Affordable Care Act of 2010 (ACA)

Signed into law on March 23,2010, the ACA seeks to increase the quality and availability of health care coverage for most Americans.

Many health policy experts argue that the problems with costs, access, health levels, and quality are symptoms of a health care delivery system that is in immediate need of tremendous reform. This chapter will explore various aspects of these problems and their causes.

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