Providers have been targeted as major factors that limit access to and escalate the cost of health care. They do play a role. Physician incomes and the cost of institutional care and fragmented services are concerns that must be adjusted. But, to revise our health care system out of context with social, political, and economic realities that drive the health care system is not likely to substantially, nor for long, increase access, decrease cost, or maintain the quality of care. Those realities include the insurance industry, the pharmaceutical and materials manufacturing industries, political action committees, regulatory agencies, liability, demographic population shifts, lifestyle patterns, and poverty. These forces operate in ways that providers can only influence as citizens of the whole.
The insurance industry has torqued the cost of patient care directly and indirectly. Between 30 and 40 million people under the age of 65 years (primarily young, at or
King RB. Nonprovider Factors That Impact Health Care Cost and Access. Arch Neurol. 1995;52(1):17–20. doi:10.1001/archneur.1995.00540250021007
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