Policy Challenges in Modern Health Care

Policy Challenges in Modern Health Care

Policy Challenges in Modern Health Care

Policy Challenges in Modern Health Care


Health care delivery in the United States is an enormously complex enterprise, and its $1.6 trillion annual expenditures involve a host of competing interests. While arguably the nation offers among the most technologically advanced medical care in the world, the American system consistently under performs relative to its resources. Gaps in financing and service delivery pose major barriers to improving health, reducing disparities, achieving universal insurance coverage, enhancing quality, controlling costs, and meeting the needs of patients and families. Bringing together twenty-five of the nation's leading experts in health care policy and public health, this book provides a much-needed perspective on how our health care system evolved, why we face the challenges that we do, and why reform is so difficult to achieve. The essays tackle tough issues including: socieconomic disadvantage, tobacco, obesity, gun violence, insurance gaps, the rationing of services, the power of special interests, medical errors, and the nursing shortage. Linking the nation's health problems to larger political, cultural, and philosophical contexts, Policy Challenges in Modern Health Care offers a compelling look at where we stand and where we need to be headed.


Our understanding of the distinctions between population health and individual health and their implications for health care and public policies in the United States remains muddled. Population health is considered the province of the public health system, while individual health is the domain of the medical care system. Although these systems both affect health, it is unclear if or how they should interact.

This book is a collection of sixteen essays prepared by awardees of the Investigator Awards in Health Policy Research, a national program of The Robert Wood Johnson Foundation. It contains chapters and public policy recommendations both on the health care system, where the underlying concept is individual health, and on population health, which emphasizes the average health of a group of people bound by common circumstances. It is the first book, to this writer's knowledge, that addresses both those domains, thereby providing an opportunity for further reflection and research. Do the factors that influence population health differ from those that influence individual health? Can we integrate those factors into a single conceptual model of health production? Can policies intended to affect the individual health system have an impact on population health, and the reverse? Is synergy latent, and achievable?

Also juxtaposed in this volume are two seemingly intractable problems that afflict health. First, mechanisms for producing population health—driven by our nation's values, culture, history, and social organization—have yielded low average health in the United States compared with other economically advanced nations. This country also faces wide disparities in health by socioeconomic status, gender, and race/ethnicity. Second, the individually oriented focus of U.S. health care has resulted in a system that is the most expensive in the world and yet is in organizational and functional disarray. Are these two problems related with respect to causes, manifestations, and the public policy solutions proposed by these authors?

The two health production systems interact despite dissimilarities. The distribution of disease in our society places a disproportionate health load on the lower . . .

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