Sociology of Health Care Reform

There is urgent need for a transparent, public process that assesses the efficiency of the U.S. health system.

The U.S. health care system often provides services that stray from scientific standards and contribute to unnecessary costs. Efforts to create a more rational system have focused on three goals: expanding access, containing costs and improving quality. These areas are interrelated; for example, deductibles and co-pays spread costs and encourage patients to be economical; however, these strategies increase the burden on the uninsured.

The premise of this article from a Journal of Health and Social Behavior supplement is that patient distrust is an obstacle to meaningful health reform. The authors organize their discussion of the health system into four themes: 1) variations in health care use and costs; 2) reimbursements as a determinant of health organization and practice; 3) how a strong professional culture can create accountability for costs and quality; and 4) the rhetoric and reality of rationing.

Key Findings:

• Because some health problems are worse than others, risk adjustment is essential for determining appropriate reimbursement arrangements.
• Kaiser-Permanente provides an exemplary model of an integrated system that has improved quality of care and minimized costs.
• Fee-for-service arrangements encourage overuse of health services.

Health expenditures in the U.S. are 18 percent of gross domestic product, and projected to be 34 percent by 2040. This article examines the shifting balance between cost-containment, quality of care and access to the U.S. health care system. The authors assert that patient trust is crucial to improving the health system.