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Future Challenges in the Health Care System 2
Both of the IOM reports have highlighted many barriers; interestingly many of them
are still there even after so many years. Five of them are discussed here:
It is the sole reason for the existence of public health activities. There is enough
inequality in access to these benefits from state to state (on macro level) and from county to
county (on micro level), as well as by social and income status. Decentralized style of
decision-making and funding from the federal level augments this inequity. In a nation like
a wide access to specified benefits is desirable. Another problem in this respect is health
insurance (or lack of it). Being uninsured is the biggest barrier to obtaining health care. More
than 41 million people (80 percent of whom are members of working families) are uninsured
Lack of well-trained public health professionals who can bring forward solutions
addressing public health problems by using appropriate technical expertise and management
skills is another major problem. Hospitals are facing shortages of RNs, in addition to
salaries and unrewarding professional environments inhibit the attraction of expertise even if
The liaison between the state and localities is usually very complex and is a result of
interaction between provisions of state constitutions, political history, and many other factors.
In most of the states, the laws describing the jurisdiction of and relationships between state
and local health agencies are very vague and lack consistency, especially in public health,
Future Challenges in the Health Care System 3
roles hampers desirable cooperation and best possible use of the distinctive capacities
that identifies problems, provides data to assist in decisions about appropriate actions, and
monitors progress. Fragmentation has developed in these systems because states and
localities have not developed uniform standards for data elements, collection procedures,
storage, and transmission. This lack of uniformity has made it difficult for states and
localities to work collaboratively among themselves or with the private sector to develop
The activities and interests of our health care delivery system and the governmental
public health agencies clearly overlap in many areas, but there is no real collaboration
between them. Policy development in public health at all levels of government is often ad
hoc, responding to the issue of the moment rather than benefiting from a careful assessment
according to an objective assessment of the possibilities for greatest impact. In many public
Conclusion
The IOM 2002 has summarized the present situation in these words “Despite this
progress, the committee found that in many important ways, the public health system that was
in disarray in 1988 remains in disarray today.” (Page 100: Institute of Medicine. The Future
of the Public’s Health in the 21st Century. (2002). The National Academies Press,
Washington, D.C.)
Future Challenges in the Health Care System 4
Reference
Institute of Medicine. The Future of the Public’s Health in the 21st Century. (2002). The
Institute of Medicine. The Future of Public Health. (1988). National Academy Press.
Washington, D.C.