chapter  1
18 Pages


Health systems affect all of us in one way or another. The individual doctor operating in a solo practice that is their private business, whom we might visit with a health concern, works within a broader system. A referral for a laboratory test or to a specialist may be required, as may be a prescription for medicines. Depending upon how health care services are funded, the doctor may have contracts or billing arrangements with a range of funders including the government, a social insurance funder, or private insurers. The doctor may also have to fulfill various government policy goals, such as collecting data on patient characteristics and health risks, providing information to patients on specific diseases or government health priorities, and delivering certain services such as screening of at-risk patients and immunizations. Doctors and other health care professionals working in hospitals and allied services spend their working lives negotiating, and helping patients negotiate, the health system. They may see patients whose conditions could have been managed in community settings or averted with better primary care service access. They will also be beholden to funding arrangements, such as billing and reimbursement systems, and to issues of service coordination.