ABSTRACT
This chapter examines the health care system as if it were a patient. It addresses the following questions: What are the major characteristics of the US health care system? And how did they get to be what they are? What trends are apparent, and how are these changing the system's crucial characteristics? What forces have produced the trends that make health reform a fundamental policy challenge for the 1990s? In the traditional retroactive payment system, providers received payment on the basis of the particular services rendered, billed after the fact. Financial incentives are a crucial part of any health care system, perhaps especially when that system is predominantly marketoriented. Health care became a major bargaining element at a time when companies were prospering on war orders and had subsidized health care benefits in the form of a tax-deductible business expense. US health care is predominantly a private matter, financially speaking.
