Chapter 1: Introduction

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INTRODUCTION

Health professionals are given significant responsibilities in our health care system. These roles may be taken for granted by patients until a pharmacist, nurse practitioner, physician assistant, physician, or others perform assigned tasks that make positive impacts upon patients and patients’ families lives in countless ways. The exemplary manner in which health professionals provide necessary care to patients is a hallmark of health professional practice and delivery of US health care. Patients are thus well served, and fellow health professionals share knowledge and expertise specific to their profession. However, there are significant problems remaining in the US health care system from a structural standpoint. In 2016, the United States spent 17.2% of the gross domestic product (GDP) on health care,¹ yet the United States ranks 37th in the world when considering outcomes of care. Comparing the United States to similar industrialized countries, we rank 11th out of 11 comparator countries, and have poorer health outcomes.² The reasons for why the United States compares poorly with other countries will be discussed in the following paragraphs.

Tremendous uncertainty surrounds the current health care system in the United States. Efforts to repeal and replace the Patient Protection and Affordable Care Act (ACA) have failed at the US Congressional level. Bipartisan calls for improving the current ACA have met with both encouragement and disdain, depending upon the point of view of those speaking. Regardless of the form of health care delivery and insurance for such, the very bright note to point out is the realization of the excellence of the delivery and outcomes of care provided by US health care professionals. Health professionals improve the health of Americans daily through many efforts and accomplishments.

A significant issue in the United States is that countless other Americans in our midst are underinsured. They may have partial coverage after a fashion, but, for these Americans, the high price of deductibles, co-pays, and monthly payments for insurance create an economic dilemma each time they seek care or pay premiums. In a comprehensive report from Kalorama Information,³ it was noted that consumer out-of-pocket health care costs have risen from $250 per year in 1980 to over $1400 in 2016. It was also noted in this report that those in less comprehensive health care coverage insurance plans have delays in treatment, which lead to increasing costs in the long term. Recently, Howard Bauchner, MD, the editor-in-chief of JAMA and The JAMA Network, has called for health professionals and professional organizations to speak with one voice and support health care coverage as a right for all.⁴

Recent US Center for Medicare and Medicaid (CMS) expenditure data projections posit that, in 2025 in the United States, a total of $4.72 trillion will be spent on health care.⁵ The projection for spending ...