Since the 1970s the U.S. health care system has experienced rapid and unprecedented change. The sites where health care is delivered have shifted from acute inpatient hospitals to outpatient settings such as ambulatory care and surgical centers, clinics, and physicians' offices as well as long-term care and rehabilitation facilities. Patterns of disease have changed from acute infectious diseases that require episodic care to chronic conditions that require ongoing care. Even threats to U.S. public health have changed—epidemics of infectious diseases have been replaced by epidemics of health risks such as obesity, mental illness, substance abuse, and physical inactivity. At the end of 2001 the threat of bioterrorism became an urgent concern of health care planners, providers, policy-makers, and the American public.
There are new health care providers—mid-level practitioners (advance practice nurses, certified nurse midwives, physician assistants, medical technologists) and new equipment for diagnosis such as magnetic resonance imaging (MRI) and genetic testing. Furthermore, the rise of managed care, explosion of biotechnology, and availability of information on the Internet have dramatically changed how health care is delivered.
Some health care industry observers suggest that the speed at which these changes have occurred has further harmed an already complicated and uncoordinated health care system. There is concern that the present health care system cannot keep pace with scientific and technological advances. Many worry that the health care system is already unable to deliver quality care to all Americans and that it is so disorganized that it will be unable to meet the needs of the growing population of older Americans.
This chapter considers several of the most pressing challenges and opportunities faced by the U.S. health care system. These include:
- Safety: Ensuring safety by protecting patients from harm or injury inflicted by the health care system—preventing medical errors, reducing hospital infections, and safeguarding consumers from medical fraud. In addition to actions to reduce problems caused by the health care system, safety and quality may be ensured by providers' use of clinical practice guidelines—standardized plans for diagnosis and treatment of disease and the effective application of technology to information and communication systems.
- Information Management: Information technology, including the Internet, has the potential to provide health care providers and consumers with timely access to medical data, patient information, and the clinical expertise of specialists. Reliable public sources of consumer and provider health information on the Internet include the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), and MEDLINE. Using this technology effectively is a health system challenge, especially in terms of protecting patient privacy and confidentiality and ensuring that consumers have access to accurate and reliable health information.
- Innovation: Widespread use of innovations in health care delivery should be recommended only after objective analysis has demonstrated that the innovation will measurably benefit the safety, effectiveness, efficiency, or timeliness of health service delivery. Innovations should also be considered if they have the potential to reduce waste of equipment, supplies, or personnel time or if they have the capacity to allocate or distribute health care more equitably. Equitable distribution refers to care that does not vary in quality based on the characteristics, such as race, gender, ethnicity, or socioeconomic status, of the population served.