Introduction: Transformations in Health Care Delivery and Financing

Abstract

Clinical decision-making ideally should be a partnership of caregiver and patient, and, where applicable, the patient’s family members or other representatives, engaged in a robust exchange of information about the individual’s specific health care needs and how they relate to, or are affected by, other aspects of the patient’s life situation and overall well-being. The reality in the United States is far from the ideal. To begin to grasp the challenges facing both patient and caregiver in structuring a productive relationship requires an understanding of the complexity of the context in which such decision-making occurs in this country.