The problems discussed, in a sense, encompass all of medical care .There is frustration with a delivery system which has expanded in number of personnel and facilities, and yet which frequently seems to be unavailable and inaccessible. Mythology still refers to the personal relationship between patient and physician. Yet many feel that this relationship has long since disappeared. Many individuals do not have their own physicians, and often they go directly to specialists. Many individual use the emergency room or the outpatient department of the hospital as their private physician. Furthermore, the time devoted by the physician to a patient visit is often so brief as to suggest that personal rapport is seldom achieved. Many consumers feel that the delivery system involves long waits for services, impersonal care unavailabilitity of care, and difficulty in finding entry the system. To compound the difficulty the consumer complains that when care is obtained he is faced, both in and out of hospital by high charges and fees. Those who purchase insurance ( both individuals and groups ) find that insurance rates are rising rapidly. Neither the public nor the unions or the employers ( or the general taxpayer ) are happy with the financial situation the second problem that bears brief discussion.
It is not at all clear that the consumer would be satisfied with the difficult he has in obtaining care and with the quality ( as he perceives it ) of the care that he receives, even if the care were purchasable at low prices and involved low total expenditures. Nor is it clear that he would be satisfied with the prices he now pays even if he received high quality care, readily available and accessible . Perhaps the consumer wants something unattainable : high quality care at low prices and expenditures. In fact, however, what he perceives as the inadequacies of the delivery system are also associated with high prices and costs. Small wonder he complains ! Nor does his health insurance policy provide sufficient protection. There is always the gnawing fear that with deductibles and coinsurance and with the maximums, he will find that his out-of-pocket expenses ( over and above the significant amounts he has paid for insurance ) represent a considerable drain on resources. The problem is compounded by various additional sociological and psychological factors. Thus , there is irritation with a payment mechanism which seems to call for high expenditures on an out- of-pocket basis as well as significant expenditures for insurance.
There is perhaps, yet an additional factor for that has brought the national health insurance discussion to the point that it has reached in recent months.
