Health Care System

A system made up of a group of independent but interrelated elements that constitute a unified whole and designed to look after the health care needs of a population. The modern health care system comprises three components: (1) personal medical care services, which are involved in prevention, diagnosis, treatment, and rehabilitation- (2) the institutions and personnel that provide these services- and (3) government, public, and private organizations, which finance service delivery. These arrangements rely on the interrelationships of the people needing the health care services- the professionals and practitioners providing the health care- and the public and private agencies organizing, planning, regulating, financing, and coordinating the services.

The health care system's concern for the delivery of services is related to access. Access is influenced by the characteristics of health care consumers, such as age, education level, economic status, race, ethnicity, cultural heritage, and geographical location. These determine when and where consumers seek health care services, their expectations of care and treatment, and the extent to which they wish to participate in decisions about their own medical care.

The evolution of the modern medical industrial complex is built on the acceptance of germ theory as a cause of disease. Prior to the 1800s, women took care of illnesses. Doctors, who had little formal training, were summoned to the home in cases of life-threatening illnesses. In the early 1800s, health care, in terms of the creation of public departments of health, emerged in the face of epidemics, such as cholera, yellow fever, and diphtheria and poor sanitation. Doctors began treating patients under one roof.

By the end of the 1920s, the first large medical insurance company, Blue Cross, was established. In the 1930s, doctors were being paid through a fee-for-service system, in which patients paid a fee for each service that they received. World War II marked the beginning of health maintenance organizations (HMOs), which would become pervasive in the 1980s.

The post-World War II era marked the beginning of an expanding workforce, advancements in medical care and medical science, an increase in health care costs, and technological advancements in drugs and equipment, which precipitated the professionalization of nonphysician therapists and technicians. In the 1960s, the U.S. government established the Centers for Disease Control, the U.S. Food and Drug Administration, and the cabinet-level Department of Health and Human Services.

By the 1980s, HMO's dominated the organization of health care and reimbursement to physicians. The fee-for-service system faded as doctors found themselves less in control of the health care services and instead working for corporations that made profits in prepaid health care by reducing costs, restricting services, and focusing on prevention. The fee-for-service was replaced by capitation, also known as managed care, a system that set a fee per patient for a given period of time. Patients, therefore, have been forced to become more directly involved in their own health care. As a result, the use of the Internet and alternative medicine have proliferated, as patients rely more on their own resources to get the care that they need. For more information, see Starr (1982).

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