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Faustina A Gyemang
There is a great influence on public health on US health care systems. The United States stands out from many other countries in not offering universal health insurance coverage. In 2010, 50 million people (16 percent of the U.S. population) were uninsured. Access to health care services, particularly in rural and frontier communities or disadvantaged urban centers, is often limited. The United States has a relatively weak foundation for primary care and a shortage of family physicians. One explanation for the health disadvantage of the United States relative to other high-income countries might be deficiencies in health services. Although the United States is renowned for its leadership in biomedical research, its cutting-edge medical technology, and its hospitals and specialists, problems with ensuring Americans’ access to the system and providing quality care have been a long-standing concern of policymakers and the public.
In the United States, health care delivery (and financing) is deeply fragmented across thousands of health systems and payers and government (e.g., Medicare and Medicaid) and the private sector, creating inefficiencies and coordination problems that may be less prevalent in countries with more centralized national health systems. As a result, U.S. patients do not always receive the care they need (and sometimes receive the care they do not need): one study estimated that Americans receive only 50 percent of recommended health care services.
It is clear that health systems—both those responsible for public health services and medical care—are instrumental in both the prevention of disease and in optimizing outcomes when illness occurs. The importance of population-based services is marked by the signature accomplishments of public health, such as the control of vaccine-preventable diseases, lead abatement, tobacco control, motor vehicle occupant restraints, and water fluoridation to prevent dental caries.
There is mounting evidence that chronic illness care requires better integration of professions and institutions to help patients manage their conditions, and that health care systems built on an acute, episodic model of care are ill-equipped to meet the longer-term and fluctuating needs of people with chronic illnesses. Wagner and colleagues (1996) were among the first to document the importance of coordination in managing chronic illnesses. Many countries differ from the United States because public health and medical care services are embedded in a centralized health system and social and health care policies are more integrated than they are in the United State.