This chapter explores the health care debate’s narrow focus on insurance as a pathway to accessibility, arguing that while necessary, it is insufficient for achieving health equity. True health equity extends beyond the point of care to address social determinants of health (SDOH) – the lived environments and socioeconomic factors that shape health outcomes. These include access to safe neighborhoods, quality education, healthy food, and housing stability, which account for nearly 80 percent of life expectancy and quality-of-life indicators. The chapter introduces frameworks like the World Health Organization’s CSDH model, illustrating the need for policies that integrate nonmedical factors into health care delivery. Highlighting examples from US policies such as Medicaid expansion and international initiatives like South Africa’s universal retroviral therapy, it emphasizes the transformative potential of addressing SDOH. Recognizing SDOH as “medicine” could redefine health care policy, fostering equity through holistic, patient-centered, and socially adaptive approaches.

This chapter explores the current state of the US health care system, highlighting its mixed performance in providing accessible, affordable, and quality care. Despite being the wealthiest nation, the US underperforms compared to peer countries, spending disproportionately on health care while achieving subpar outcomes. The chapter examines key challenges, including fractured public health infrastructure, high costs driven by price per service, and significant disparities in access and equity. Comparative analysis with international systems underscores the inefficiencies in the US approach while offering insights for reform. Methods for evaluating health care performance – trendline analysis, optimization modeling, and benchmarking – are discussed, with an emphasis on the utility of cross-national comparisons. The chapter introduces critical themes of access, affordability, and equity while advocating for a shift from cost-focused solutions to strategies that enhance value. These foundational perspectives set the stage for exploring actionable reforms to improve US health care outcomes and system sustainability.

This chapter introduces the fundamental premise that achieving a healthy society requires moving beyond access to clinical care and addressing the broader social determinants of health. While access to quality health care is essential, factors outside clinical settings – such as economic stability, education, social equity, and the built environment – account for 80 percent of health outcomes. The chapter explores health equity and justice, distinguishing these concepts from equality and advocating for systemic changes to address underlying inequalities. Various global health care models (Beveridge, Bismarck, National Health Insurance, and Out-of-Pocket) are presented, highlighting the fragmented nature of the US system. The 6Ps framework (patients, policy makers, providers, pharmacies, pharmaceuticals, and payers) is introduced as a tool to analyze and optimize health care policy. Finally, the chapter emphasizes the interplay between diversity, health, and policy, illustrating the importance of inclusivity and justice in creating equitable and effective health systems.

This final chapter brings the themes of the book to a meaningful conclusion by focusing on the evolving roles of patients and providers in fostering a more inclusive and equitable health care system. It emphasizes patient-centric care, where patients actively participate in decision-making processes, validating their voices as integral to health care delivery. The chapter explores Community-Engaged Health care as a transformative model that empowers communities and addresses health disparities. It also examines financial incentive models, advocating for a shift from fee-for-service structures to value-based care and patient-reported outcome measures to align care with patient needs. Drawing lessons from the pandemic, the chapter highlights the benefits of community-centered care and expanded provider roles. Concluding the book’s journey through the complexities of health care policy, it calls for collaborative efforts among stakeholders – the 6 Ps (patients, policy makers, pharmacies, pharmaceuticals, payers, and providers) – to establish patient-focused health care policies that prioritize people over politics, leaving readers with a vision for an inclusive health care future.