Chapter 11: The Health Care System & Public Health

The private subsystem focuses primarily on individual care and is composed of profit, nonprofit, and voluntary agencies that offer services ranging from primary health promotion to specialized rehabilitation and custodial care. In contrast, the public health subsystem is legally mandated to protect population health through federal, state, and local government actions. At the federal level, the Department of Health and Human Services (HHS) oversees critical agencies such as the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH) to manage national health initiatives, research, and disaster relief. Individual states serve as the central authorities for health laws and the administration of programs like Medicaid, while local health departments act as the primary providers of direct community services, including immunizations, environmental inspections, and maternal-child health programs. The chapter emphasizes the necessity of an interprofessional health care team, highlighting the evolving roles of various nursing professionals—such as Advanced Nurse Practitioners, Clinical Nurse Leaders, and Nurse-Midwives—and their significant impact on care coordination and patient outcomes. Substantial attention is given to health care quality and safety, referencing landmark reports from the National Academy of Medicine that address systemic errors and promote evidence-based practice through organizations like the Agency for Healthcare Research and Quality (AHRQ). Modern health care delivery is further shaped by managed care models, the integration of information technology—specifically Electronic Health Records (EHR) and telehealth—and the ongoing influence of the Patient Protection and Affordable Care Act (ACA). The text also explores critical challenges such as persistent health disparities affecting marginalized populations based on race, ethnicity, and socioeconomic status. It underscores the urgency of addressing these inequities and the importance of patient rights, including autonomy and confidentiality. Ultimately, the future of nursing and public health lies in transitioning toward patient-centered, community-based models that prioritize disease prevention, health promotion, and seamless collaboration among all health providers to enhance accessibility and efficiency across the wellness-illness continuum.