Abstract
The purpose of this study was to explore and propose possible alternatives to the current U.S. health and medical care system—as informed by the literature and by healthcare, economic, public policy, futures, and theory expert's participating on Delphi expert panels. Four research questions were addressed that investigated the strengths and weaknesses of the current healthcare system, examined whether improving community health status was an objective of current U.S. health policy, and explored the qualities and attributes of a potential universal access health and medical care system regarding cost, quality, and access. A theory base was developed which suggested that a system of universal access to health and medical care could be validated through a fusion of economic and social justice theories. A model of the fusion theory was also developed. The Delphi methodology was used to select a sample of experts in five fields related to health services and three rounds of surveys were administered through these experts to obtain a consensus on a desired future state for U.S. health policy. A consensus among the experts validated the researcher's theory base, identified the major strengths and weaknesses of the current U.S. healthcare system, and suggested that a multipayor universal access system implemented over a five-to-seven-year period would lower costs, improve quality, and open access to healthcare for all U.S. residents. A chi-square analysis was conducted on system design preferences which validated the finding of the experts that conversion to a system that provided universal access to health and medical care would create a new healthcare system that would be more efficient, more effective, and more equitable. Finally, recommendations were made regarding the implementation of a universal access system including implications for safety net providers.