Examines the complex interrelationships that inform the health care system. Health care, like all social systems, is a product of thought. Up to now, our collective thinking has been based on trying to manage parts, not the whole. This book inquires into four age-old questions that shape all health care systems: What is health? What is care? Who is responsible? How much is enough?

Americans have the wealthiest health care system in the world, yet the health status of Americans ranks in the lowest quartile among the world’s 25 industrialized nations and 45 million Americans are without health insurance. Today’s cost, quality, and access problems are inter-related and can be traced to taken-for-granted assumptions and health care’s outmoded organizing concepts: reductionism and materialism. Greater fragmentation of care, an over-dependence on technology, inattention to social and environmental determinants of health, and serious economic and moral dilemmas are some of the results of the last 40 years of piecemeal political and economic reform.

This book has three purposes. The first is to help the reader see healthcare as a complex system-a part in a larger whole-and to show how answers to the questions, What is health? What is care? Who is responsible? How much is enough? implicitly define the purpose, effectiveness, efficiency, and fairness of a health care system. The second is to show that today’s access, cost, and quality problems are interrelated, and arise from outmoded concepts, unquestioned assumptions, and a long trail of inconsistent and contradictory answers to the four questions. The third purpose is to acquaint readers with both the personal and societal challenges of finding coherent answers to the four questions raised above and to describe some of the budding experimental solutions that challenge traditional conventions and assumptions.