ABSTRACT
The American health care system faces three parallel critical policy challenges: controlling rising health care expenditures, increasing access for 42.5 million uninsured and approximately 18 million under-insured individuals, and delivering high-quality services. The phenomenon of third-party payers for health coverage has been a driving force in shaping the health care system in the United States for many years. As recently as 1960, most health care expenditures were paid as out-of-pocket expenses by consumers. Since 1973, federal statutes have been important in developing the framework for addressing the tensions between consumers, providers, and third-party payers in the era of managed care. Health care policy-making and regulation can be characterized as reflecting the interests and interactions among consumers, providers, and third-party payers. The transformation of the American health care system to one dominated by managed care has led to a renewed emphasis on patient rights and consumer protection.
