Healthcare systems

A healthcare system can be defined as the method by which healthcare is financed, organized, and delivered to a population. It includes issues of access (for whom and to which services), expenditures, and resources (healthcare workers and facilities). The goal of a healthcare system is to enhance the health of the population in the most effective manner possible in light of a society's available resources and competing needs. By the beginning of the twenty-first century access to healthcare had come to be regarded by most countries and the United Nations as a special good that is necessary either as a matter of or pursuant to basic human rights. An examination of healthcare systems therefore includes consideration of the ways in which a particular system addresses commonly held values.

The extent and form of a specific system are influenced by a variety of factors, including the unique culture and history of a population or country. What is considered healthcare can vary markedly in accordance with a country's level of development, culture, and social values. Some populations put emphasis on the prevention of disease, whereas others emphasize only the care for or cure of particular illnesses. Definitions of health and disease and of appropriate healthcare providers also are subject to cultural variability.

A second major influence derives from the priorities given to various ethical values: "There is no way to adjudicate disputes among the Holy Trinity of cost, quality and access unless a court of values is available to dispense its wisdom" (Reinhard, pg. 1). Those values include respect for the autonomy of both patients and providers, the maximization of benefit, and the promotion of justice or fairness, understood as equality or liberty.

Balancing those values has posed a dilemma in the United States. Public opinion polls have revealed that most Americans see access to healthcare as a fundamental right. However, Americans' equally strong belief in individual autonomy and responsibility, the use of the market as a means for distributing goods and services, and fears about government interference create conflict and have led to a fragmented healthcare system.

A third influence on the structure of a healthcare system is the level of economic resources available. There is a strong positive correlation between economic resources as measured by the per capita gross domestic product (GDP) and both healthcare expenditures and the proportion of a nation's GDP that is spent on healthcare (Gerdtham and Jonsson). This indicates that although healthcare generally is valued, countries and individuals may consider food, shelter, and in some instances spending for the military more important. However, although the economic resources available to a country have a great effect on that country's overall expenditures on healthcare, there is nearly as much variation in the forms of the healthcare systems in countries that are economically poor as there is in wealthy countries.

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