HEALTH POLICY

Health Policy



Executive Summary

Health care is assumed to be able to cope better with the changing pattern of disease than hospital-oriented health care. Strong health care has a generalist approach, taking into account the social and family context of patients, and provides continuity, comprehensiveness and coordination. Health care can counteract the current fragmentation of health care by guiding patients through the system where necessary. Countries with a strong health care system might be able to develop more comprehensive models to manage and coordinate care for long-term conditions. However, the problem-solving ability of health care would benefit from integration of health care and social care, in order to better support people in self management of their situation and to facilitate their living longer at home and in the community. Also, the integration of health care and public health is important for tackling health inequalities, especially in areas with low social cohesion. Health care favors access to care for the population in general and minority groups in particular. Health care is also more responsive to patients' needs and preferences.

Health Policy

Influencing Health Policy

The Importance of Public Health

A health system's primary objective should be the improvement of the population's health. To advance this goal, policymakers must concentrate on disease prevention and health promotion, rather than on health care services, which largely address the symptoms of diseases that have already manifested. In other words, an effective health system must be public health oriented in order to eliminate the underlying causes of disease, thereby avoiding unnecessary costs and morbidity. Health promotion and disease prevention have a far greater impact on health status than do health care services. Inadequate accesses to medical interventions are not the primary cause of premature morbidity and mortality. Rather, “nine preventable conditions are responsible for more than 50% of all deaths in the United States.” Diseases result from a combination of individual behavioral factors (e.g., smoking, diet, physical activity, and sexual behavior), the environment in which people live (e.g., pollution, toxic chemical exposure, and contaminated food), and the social determinants of health (e.g., education, income, and housing).

Evidence indicates that preventive interventions targeting these root causes of disease account for approximately 80 percent of the reduction in morbidity and mortality we have achieved, whereas health care is responsible for less than 20 percent(Wohl, 2004). Instead of upfront investments in prevention and wellness, the nation spends billions of dollars on high technology interventions to treat conditions that might otherwise have been prevented or lessened in severity. Effective public health “reduces the need for medical services to treat conditions that can be prevented, thereby helping to control costs and making personal health care affordable.” Patients with complex chronic conditions (which now represent the majority of the disease burden) cause very high, potentially avoidable medical costs. For example, in 2002, heart disease and trauma accounted for the largest share of health care spending. Individual behaviors — e.g., helmet and seatbelt use, firearms safety mechanisms and accessibility, intoxicated machine operation, exposure to toxic agents, ...