The health care system consists of all personal medical care services—prevention, diagnosis, treatment, and rehabilitation (services to restore function and independence)—plus the institutions and personnel that provide these services and the government, public, and private organizations and agencies that finance service delivery.
The health care system may be viewed as a complex made up of three interrelated components: people in need of health care services, called health care consumers; people who deliver health care services—the professionals and practitioners called health care providers; and the systematic arrangements for delivering health care—the public and private agencies that organize, plan, regulate, finance, and coordinate services—called the institutions or organizations of the health care system. The institutional component includes hospitals, clinics, and home-health agencies; the insurance companies and programs that pay for services like Blue Cross/Blue Shield, managed-care plans such as health maintenance organizations (HMOs), and preferred provider organizations (PPOs); and entitlement programs like Medicare and Medicaid (federal and state government public assistance programs). Other institutions are the professional schools that train students for careers in medical, public health, dental, and allied health professions, such as nursing. Also included are agencies and associations that research and monitor the quality of health care services; license and accreditation providers and institutions; local, state, and national professional societies; and the companies that produce medical technology, equipment, and pharmaceuticals.
Much of the interaction among the three components of the health care system occurs directly between individual health care consumers and providers. Other interactions are indirect and impersonal such as immunization programs or screening to detect disease, performed by public health agencies for whole populations. All health care delivery does, however, depend on interactions among all three components. The ability to benefit from health care depends on an individual's or group's ability to gain entry to the health care system. The process of gaining entry to the health care system is referred to as access, and many factors can affect access to health care. This chapter provides an overview of how Americans access the health care system.