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This chapter states that the fulfilment of such basic needs such as freedom from illness, malnutrition, and premature death may well be correlated with income, but that this relationship is unlikely to be close. It also states that the capability of people to live long and healthy lives is an important aspect of welfare, but that this is not measured by the income they receive. It is also stated in the chapter that many major health hazards in developing countries with rather high mortality rates now have inexpensive solutions. The chapter goes on to discuss the institutional divide of medical health care in China, as well as the health-care provision and access distribution between rural and urban China. It then discusses the health-care finances available and the health outcomes in the country.

This chapter examines archetypes of health care systems, from various European national health systems to the centrally planned model of the former Soviet Union and the market-driven US model. The chapter then analyzes two key health care policy approaches: primary health care and universal health coverage. It provides illustrations of recent and ongoing health system reforms across all world regions (covering China, Thailand, the Middle East, Brazil, Mexico, South Africa, South Korea, and India) that address—to varying degrees—questions of regulation, financing, resource allocation, the nature of service provision, and principles of universality, access, affordability, quality, and equity within the politics of their context. In addition, it provides an overview of the building blocks of health care systems including facilities, different types of health care personnel, problems around health workforce migration, technology, and the powerful role of the pharmaceutical industry.

This chapter addresses the issue of health care for low-income people. The United States, virtually alone among developed nations, does not offer universal access to health care, leaving many millions of individuals without health insurance or other means of obtaining necessary medical services. In 2010, Congress enacted the landmark Patient Protection and Affordable Care Act (ACA)—popularly known as “Obamacare”—marking an important but incomplete response to the nation’s health care crisis. This chapter examines the ACA in detail, including its impact on Medicaid and Medicare, the major government health programs in the United States, its creation of Health Insurance Exchanges and tax credits to help low-income households obtain private health coverage, and the reform of private health insurance markets through a patient’s bill of rights, which, among other measures, prohibits insurance companies from refusing coverage for preexisting medical conditions. Perhaps the most critical aspect of the ACA was its expansion of Medicaid to cover virtually all low-income citizens (and certain immigrants) who do not qualify for other health coverage. Although several states opted out of the ACA’s Medicaid expansion, the Medicaid program nevertheless remains the largest single provider of health coverage in the United States. This chapter also provides a detailed description of Medicaid, its eligibility criteria and scope of coverage; the Child Health Insurance Program (CHIP), a government-funded health insurance program for children in households with too much income to qualify for Medicaid; and Medicare, the federal health insurance program for aged, blind, and disabled individuals.

This chapter presents background on the nature of health policy and the role of regulation in translating policy into action. It describes the fundamental policy goals of improving quality, enhancing access, and controlling costs and the ways in which they compete, as improvements in one goal inevitably harm one or both of the others. Over the course of the 20th century, the primary emphasis of most new regulatory initiatives evolved from quality to access to cost. The chapter then explains the process of regulation and the legal rules for governmental regulatory agencies, particularly the federal Administrative Procedures Act. It also describes the basic structure of the largest regulatory body of all, the Federal Department of Health and Human Services. It concludes with a discussion of perennial policy conflicts, including the balance between regulation and market forces, between private and governmental regulation, and between state and federal primacy in regulation.

This chapter attempts to detangle the issue of the rising cost of health care from things that are harder to measure, such as our expectation about the level of health care we need and deserve. Topics discussed include societal expectations about good health, diminishing health care access and expectations, reading the expectations of many stakeholders, and stakeholder alignment and value creation.

In this chapter, the focus shifts to consider medical tourism from the destination country perspective. A number of authors, scholarly and popular, have critiqued medical tourism’s inequities: vast medico-industrial complexes, replete with the newest expensive technologies to provide comparatively wealthy medical tourists with hip replacements and facelifts, coexist with large swaths of the population dying from malaria, AIDS, and lack of basic sanitation and clean water. These disparities raise several interesting fundamental questions that are the subject of this chapter: first, under what conditions is medical tourism likely to produce negative consequences on health care access in less developed destination countries, and is there good evidence it is having that effect? Second, as a moral matter of global justice, what responsibility do home countries and others bear for health care access disparities related to medical tourism? And finally, what kinds of regulations might best ameliorate such potential negative consequences?

This chapter covers the principles of health services research, which is critical for understanding and reducing the burden of neurological disease across populations. The goal of neurologic health services research is to create a scientific basis for measurably improving the care that is provided to patients with both chronic and acute neurological conditions. It is multi-disciplinary research that draws on the expertise of neurologists trained in clinical research methods, economists, biostatisticians, epidemiologists, sociologists, and other social scientists. Typical sources of data for health services research studies are surveys and interviews, medical records, and administrative data sets. Most health services researchers employ a combination of quantitative and qualitative research methods, and they work in collaboration with health care administrators and organizations in which health care is provided in the US. The chapter encompasses the design and execution of studies of access to care, quality of care and outcomes research, effectiveness, and cost-effectiveness.

This chapter explores how persons with disabilities find doctors and other health care professionals to provide primary and specialty care. It presents information about health care services used by persons with disabilities. It looks at different approaches for paying for health care services and describes how persons with disabilities must pay considerable costs out-of-pocket. The costs of accommodating disabilities, such as expenses for sign language interpreters, are also described. The chapter addresses a particularly challenging problem, as young adults with disabilities try to transition from the pediatric health care settings of childhood into the adult health care sector.

This chapter describes the physical barriers persons with disabilities can encounter when they visit health care settings, including difficulties opening doors, inaccessible restroom facilities, and examining tables that are too high for persons to access. It also examines problems encountered by patients who have blind or low vision as they try to navigate health care settings, including staff being unaware of appropriate ways to assist them with transiting through space (e.g., use of sighted guides). The chapter presents information about relatively low use of screening and preventive services among persons with mobility problems, and relates these findings to inaccessible equipment and other access barriers. Given higher rates of obesity and overweightness among persons with disabilities, particular issues relating to access for persons who are obese are also discussed.

This chapter addresses the design of health care settings that are accessible to persons with physical and sensory disabilities. It starts by reviewing Americans with Disabilities Act regulations. It then discusses a process for designing accessible space, including the involvement of persons with disabilities as partners. The chapter reviews such items as lighting, acoustics, flooring, air quality, heating and cooling, emergency notification alarms, and signage as well as basic questions about the size and configuration of spaces, medical equipment, and furniture. It offers suggestions about accessible equipment, such as weight scales.

This chapter examines the contextual factors related to the occurrence and risk of asthma, health behaviors, access to health care, and the design of effective interventions to reduce the burden of asthma. The latter is exemplified through the discussion of a specific community-based approach to asthma management: the Neighborhood Asthma Coalition.

This chapter deals primarily with the impact of social injustice on children in the United States, emphasizing children's rights in a legal context. It covers the legal status of children in society, the impact of social injustice on children's health, underlying factors and roots of this social injustice, and what needs to be done. The chapter concludes that the well-being of children depends on many investments, such as adequate family income, safe housing neighbors, and caregivers whose own lives are sufficiently supported to be able to invest time in and nurture their children. It also includes boxes on how the United States compares with other developed countries, and saving children's lives in developing countries.

This chapter compiles data on health care coverage and access in twenty countries in Latin America. It summarizes legal coverage in the three health sectors and by population groups, and examines whether coverage targets have been met. It calculates coverage of the total population, as well as by sector, location, income, and groups difficult to incorporate. It compares coverage before and after the reforms; estimates access and utilization of services; and explores the causes of the failure to meet the universal coverage goal in some countries.

This chapter discusses how different purchasers have endeavored to hold down health-related expenses while purchasing health care access for their beneficiaries. It presents a case vignette about a company that has made a very extensive investment in improving health care access and interventional strategies against illness for its workforce. This company has drawn on myriad ideas, tools, and philosophies and contracted with several partners to implement this approach. The possible cost-savings benefits from healthier lifestyles and lower morbidity have not yet been fully realized, which is what makes this example compelling, especially regarding the expectations of all the stakeholders involved. We have an opportunity to witness whether a well-planned endeavor targeting employee health will bring the benefits that are hoped for.

There has been a sharp increase in forced displacement in recent decades, particularly of urban refugees who comprise 60% of refugees worldwide. Urban refugees are largely concentrated in the developing world. Non-recognition of their status as refugees in countries of asylum contributes to unique legal, social, and material precarity which engenders a range of protection challenges, including health risks. This chapter provides an operational definition for urban refugees and discuss their unique health risks within the legal and policy contexts they live in, their access to health care, and the challenges experienced by host countries grappling with resource constraints and stretched health-care systems.

This introductory chapter provides demographic information about the prevalence of disability among U.S. residents and outlines population trends suggesting rising numbers of persons with disabilities. It also reviews concerns about health care quality in the United States, drawing upon reports of the Institute of Medicine and other sources to describe worrisome quality shortfalls, especially affecting persons with chronic health conditions. It suggests that persons with disabilities confront particular risks of receiving substandard care, along a variety of dimensions of quality and access.

This chapter examines perceptions of cancer surgery from a social, cultural, and historical standpoint by focusing on Gandie's rejection of surgery. After reviewing some developments in health care provision since the founding of the People's Republic of China (1949) at the national, provincial, county, and village level, the chapter looks at some early reactions to the implementation of the rural cooperative medical system (a collective health insurance program) and how it has influenced perceptions of health care as well as patterns of health care access. It also considers the importance of social relations and social identities involved in decision making, suggesting that economic reductionism does not fully explain the complex negotiations surrounding illness and care. It argues that Gandie's rejection of surgery reflects a moral response to the commodification of health care and thus constitutes an active engagement both with the healing process and with values of the Maoist past and the reformist present.

This chapter starts by considering the Americans with Disabilities Act and regulatory requirements for ensuring effective communications with persons with disabilities. It then reviews approaches for accommodating communication needs, ranging from simple approaches (such as large point fonts and Braille signage) to an increasingly sophisticated range of communication technologies for persons with a wide variety of accommodation needs. For example, the chapter describes various technologies that assist persons who are blind or who have low vision, as well as communication strategies and technologies for persons who are deaf or hard of hearing. It also describes the training and professional obligations of sign language interpreters.

This chapter is about secondary level prevention: that is, the restoration of health and alleviation of illness symptoms. It is argued that it is at the level that there is greatest commercial potential for health providers. Gross inequalities in access to health care at a global level are considered in relation to the migration of health workers from low- and middle-income countries to high-income countries. Examples of age-related inequalities and age discrimination considered include the neglect and abuse of older people within healthcare systems and the inadequate attention given to health conditions that affect older people disproportionately. Health care systems are increasingly attuned to the rise in chronic and non-communicable diseases (NCDs) but the imperative to contain costs impedes effective development. It is argued that there is a need for a better understanding of older people's experiences of living with chronic illness and of the importance of age to illness experience.