Session 1
Reading - Chapter 1
Major Themes
- The impressive accomplishments of the US health care system are offset by the persistent problems of unacceptable increases in costs, inexplicable variations in performance, and limited access for a significant number of Americans.
- The commercialization of the health care industry has replaced the historic charitable and social orientation of its institutions and providers with attitudes that are aggressively entrepreneurial and fiercely competitive.
- The privileged relationship between patient and physician that once was sacred in health care is now subject to scrutiny by insurers, payers, managers, and quality overseers.
- Patients, entering the complex modern health care system are well advised not to abdicate their responsibility to participate in decisions about their health care.
- The paradigms for the natural history of disease and levels of prevention illustrate how health care interventions can prevent a disease, or if established, interrupt its progression at key points in its development. The paradigms also reflect the focus of American health care on curative rather than preventive medicine.
- The major stakeholders in the health care system, their values, roles, and degrees of influence have had much to do with shaping the existing system. Health care reforms, and particularly, managed care, have repositioned stakeholders in the power structure of the system.
- The impressive advances in health care technology have had both positive and negative effects on health care costs, effectiveness, and risk to patients. The investment in, and promotion of, technology requires much more careful assessment of the risks and benefits to patients of new and existing technical developments.
- Among current and future issues of concern are: the aging of the US population; the significant numbers of uninsured Americans; the variable quality of health care; conflicts of interest among providers; and the ethical issues that arise with new advances in medicine.