Health care in the United States far outspends that of any other nation, measured both in per capita spending and as a percentage of GDP.
Yet, the country has significantly worse healthcare outcomes when compared to peer nations.
The United States is the only developed nation without a system of universal health care, with a large proportion of its population not carrying health insurance, a substantial factor in the country’s excess mortality.
Healthcare is provided by insurance companies, healthcare providers, hospital systems, and independent providers.
Health care facilities are largely owned and operated by private sector businesses.
58% of community hospitals in the United States are non-profit, 21% are government-owned, and 21% are for-profit.
Healthcare coverage is provided through a combination of private health insurance and public health coverage (e.g., Medicare, Medicaid).
Most of health spending is paid for by government programs: Medicare, Medicaid, the Children’s Health Insurance Program, Tricare, and the Veterans Health Administration.
People younger than 65 acquire insurance via their employer, by purchasing health insurance on their own, getting government and/or other assistance based on income or another condition, or are uninsured.
Health insurance for public sector employees is primarily provided by the government in its role as employer.
Managed care, where payers use various techniques intended to improve quality and limit cost, has become ubiquitous.
The United States has the highest or near-highest prevalence of obesity, car accidents, infant mortality, heart and lung disease, sexually transmitted infections, adolescent pregnancies, injuries, and homicides.
Data suggests the US healthcare system to be the most expensive and worst-performing in terms of health access, efficiency, and equity.
The US has the lowest life expectancy among 10 countries in the OECD, four years less than the average.
The US link ranks last on measures of preventable, mortality and treatable mortality among OECD nations.
In the United States, has created a market for a private employment-based system.
There is a 20% difference in lifetime health care expenditures: women greater than men.
Unlike most developed nations, the US health system does not provide health care to the country’s entire population.
Most citizens are covered by a combination of private insurance and various federal and state programs.
Health insurance is most commonly acquired through a group plan tied to an employer, covering 150 million people.
Other major sources include Medicaid, covering 80+million, Medicare, >67million, and health insurance marketplaces created by the Affordable Care Act (ACA) covering around 17 million.
Several studies have indicated that there is an association with expansion of the ACA and factors associated with better health outcomes such as having a regular source of care and the ability to afford care.
Medical debt contributes to a high percentage of all personal bankruptcies in the US.
In2013 study found that about 25% of all senior citizens declare bankruptcy due to medical expenses.
The uninsured are often treated, but the cost is covered through taxes and other fees which shift the cost.
Lost medical care due to extensive cost sharing may ultimately increase costs due to downstream medical issues; plays a part in United States’ international ranking as having the highest health-care expenditures despite significant patient cost-sharing.
Many people are insured but may be underinsured such that they cannot afford adequate medical care.
Use of care declines with increasing patient cost-sharing obligation.
In 2019, the under-five child mortality rate was 6.5 deaths per 1000 live births, placing the United States 33rd of 37 OECD countries.
Maternal deaths related to childbirth have shown recent increases.
The American rate is double the maternal mortality rate in Belgium or Canada, and more than triple the rate in the Finland as well as several other Western European countries.
Life expectancy at birth in the United States is 79.8, ranking it 42nd in the world.
Monaco is first on this list of 224, with an average life expectancy of 89.5.
The United States was at or near the top in infant mortality, heart and lung disease, sexually transmitted infections, adolescent pregnancies, injuries, homicides, and rates of disability.
The top three causes of death among both sexes and all ages in the United States have consistently remained cardiovascular diseases (ranked 1st), neoplasms (2nd) and neurological disorders (3rd).
A large proportion of health outcomes and early mortality can be attributed to factors other than communicable or non-communicable disease.
Older data (2013) concluded, more than half the men who die before the age of 50 die due to murder (19%), traffic accidents (18%), and other accidents (16%).
For women, the percentages are different: 53% of women who die before the age of 50 die due to disease, whereas 38% die due to accidents, homicide, and suicide.
Diseases of despair (drug overdoses, alcoholic liver disease and suicide), which started increasing in the early 1990s, kill roughly 158,000 Americans a year as of 2018.
In the United States, ownership of the healthcare system is mainly in private hands, though federal, state, county, and city governments also own certain facilities.
Non-profit hospitals share of total hospital capacity has remained relatively stable at about 70%.
Integrated delivery systems, where the provider and the insurer share the risk have grown in popularity.
The U.S. Department of Defense operates field hospitals as well as permanent hospitals via the Military Health System to provide military-funded care to active military personnel.
The federal Veterans Health Administration operates VA hospitals open only to veterans.
The Indian Health Service (IHS) operates facilities open only to Native Americans from recognized tribes.
Hospitals provide some outpatient care in their emergency rooms and specialty clinics.
Hospitals primarily exist to provide inpatient care.
Hospital emergency departments and urgent care centers provide sporadic problem-focused care.
Surgicenters are examples of specialty clinics.
Hospice services are for the terminally ill who are expected to live six months or less.
Services, particularly urgent-care services, may also be delivered remotely via telemedicine.
Other health care facilities include long-term housing facilities which as of 2019, there were 15,600 nursing homes across the United States.
The research and development of medical devices and pharmaceuticals is supported by both public and private sources of funding.
The expenditure on health services for people over 45 years old is 8.3 times the maximum of that of those under 45 years old.
U.S. healthcare costs exceed those of other countries, relative to the size of the economy or GDP.
The U.S. spends more as a percentage of GDP than similar countries,
higher prices for services themselves, higher costs to administer the system, or more utilization of these services, or to a combination of these elements.
Health care costs rising far faster than inflation have been a major driver for health care reform in the United States.
The combination of high prices and high volume can cause particular expense; in the U.S., high-margin high-volume procedures include angioplasties, c-sections, knee replacements, and CT and MRI scans; CT and MRI scans also showed higher utilization in the United States.
In 2024, federal spending on mandatory health programs – including Medicare, Medicaid, and Obamacare subsidies – is forecasted to reach $1.67 trillion.
By 2033 federal spending on these health programs is projected to skyrocket to $3.103 trillion.Jan 26, 2024
In the United States, about 31% of healthcare spending goes to hospital care, 21% goes to physician/clinical services, 10% to pharmaceuticals, 4% to dental, 6% to nursing homes and 3% to home health care, 3% for other retail products, 3% for government public health activities, 7% to administrative costs, 7% to investment, and 6% to other professional services (physical therapists, optometrists, etc.).
The health care system seems dysfunctional as a result of a system of third-party payments from insurers removes the patient as a major participant in the financial and medical choices that affect costs, and government intervention has expanded insurance availability through programs such as Medicare and Medicaid, this has exacerbated the problem.
Increased utilization is the primary driver of rising health care costs in the U.S.: including rising consumer demand, new treatments, more intensive diagnostic testing, lifestyle factors, the movement to broader-access plans, higher-priced technologies, and cost-shifting from government programs to private payers.
The U.S. Department of Health and Human Services oversees the various federal agencies involved in health care.
The health agencies are a part of the U.S. Public Health Service, and include the Food and Drug Administration, which certifies the safety of food, effectiveness of drugs and medical products, the Centers for Disease Prevention, which prevents disease, premature death, and disability, the Agency of Health Care Research and Quality, the Agency Toxic Substances and Disease Registry, which regulates hazardous spills of toxic substances, and the National Institutes of Health, which conducts medical research.
State governments maintain state health departments, and local counties and municipalities, often have their own health departments, usually branches of the state health department.
The federal government required that all states implement Certificate of Need (CON) programs.
It is required that hospital emergency departments treat emergency conditions of all patients regardless of their ability to pay and is considered a critical element in the safety net.
Indirect payments and reimbursements through federal and state government programs have never fully compensated public and private hospitals for the full cost of care.
More than half of all emergency care in the U.S. now goes uncompensated.
Health care quality assurance consists of the activities intended to assure or improve the quality of care in either a defined medical setting or a program.
The US health care delivery system unevenly provides medical care of varying quality to its population.[127]
A highly effective health care system, individuals would receive reliable care that meets their needs and is based on the best scientific knowledge available.
To monitor and evaluate system effectiveness, researchers and policy makers track system measures and trends over time: The US Department of Health and Human Services(HHS) populates a publicly available dashboard called the Health System Measurement Project (healthmeasures.aspe.hhs.gov),to ensure a robust monitoring system.
Uninsured patients experience longer waiting times, and patients with poor insurance coverage probably face a disproportionate number of long waits.
American health care tends to rely on rationing by exclusion-uninsured and underinsured, out-of-pocket costs for the insured, fixed payments per case to hospitals resulting in very short stays. and contracts that manage demand instead.
While life expectancy is one measure, United States Department of Health and Human Services uses a composite health measure that estimates not only the average length of life, but also, the part of life expectancy that is expected to be in good or better health, as well as free of activity limitations.
The US healthcare system does not sufficiently promote wellness.
Health gains do not accrue equally to the entire population: In the United States, disparities in health care and health outcomes are widespread.
Minorities are more likely to develop serious illnesses (type 2 diabetes, heart disease and colon cancer) and less likely to have access to quality health care, including preventative services.
Studies find that although the U.S. health care system is the most expensive in the world, it ranks low on most dimensions of performance when compared with Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom.
The studies find that the United States failed to achieve better outcomes than other countries, and is last or near last in terms of access, efficiency and equity.
The US spends huge sums of money for some of the worst health outcomes in the Western world.
The Organisation for Economic Co-operation and Development finds that the U.S. ranked poorly in terms of years of potential life lost,a statistical measure of years of lunder the age of 70 that were amenable to being saved by health care:
Among OECD nationthe United States ranked third last for the health care of women and fifth last for men.
The life expectancy gap is growing between rich and poor and by educational level, but narrowing between men and women and by race.
The mortality gap between the well-educated and the poorly educated widened significantly due to risk factors such as smoking, obesity and high blood pressure.
Deaths attributed to smoking, on the decline in the US, will drop dramatically, improving life expectancy.
One-fifth to one-third of the life expectancy difference can be attributed to obesity which is the worst in the world and has been increasing.
There is little correlation between the WHO rankings for health systems and the stated satisfaction of citizens using those systems.
The increase in babies born with low birth weights can be attributed to women delaying childbearing and the increased use of fertility drugs.
Variations in the efficiency of health care delivery can cause variations in outcomes.
Marked variations in how medical resources are distributed and used in the United States were accompanied by marked variations in outcomes.
The willingness of physicians to work in an area varies with the income of the area and the amenities it offers, a situation aggravated by a general shortage of doctors in the United States, particularly those who offer primary care.
The Affordable Care Act is anticipated to produce an additional demand for services which the existing stable of primary care doctors will be unable to fill, particularly in economically depressed areas.
The United States has been assessed as worst health-care system overall among 11 high-income countries in every report, even though it spends the highest proportion of its gross domestic product on health care.
In 2021 Norway, the Netherlands and Australia were the top-performing countries.
The United States spent 16.8% of GDP on health care in 2019; the next highest country on the list was Switzerland, at 11.3% of GDP.
The lowest was New Zealand, which spent roughly 9% of its GDP on health care in 2019.
Preventable deaths:
coronary artery disease, lung cancer, stroke, chronic obstructive pulmonary diseases, and traffic accidents caused the most years of life lost in the US.
Low back pain, depression, musculoskeletal disorders, neck pain, and anxiety caused the most years lost to disability.
The most deleterious health risk factors are: poor diet, tobacco smoking, obesity, high blood pressure, high blood sugar, physical inactivity, and alcohol use.
Alzheimer’s disease, drug abuse, kidney disease and cancer, and falls cause the most additional years of life lost over their age-adjusted rates.
The 19 next most wealthy countries by GDP all pay less than half what the U.S. does for health care, they have all gained about six years of life expectancy more than the U.S. since 1970.
Uninsured Americans are less likely to have regular health care and use preventive services.
Uninsured are also more likely to delay seeking care, resulting in more medical crises, which are more expensive than ongoing treatment.
The uninsured are less likely than the insured to receive any medical care after an accidental injury or the onset of a new chronic condition.
The uninsured with an injury or new chronic condition are less likely as to receive recommended follow-up care.
Uninsured patients are twice as likely to visit hospital emergency rooms as those with insurance.
Individuals who lack insurance are more likely to be diagnosed with late-stage cancer than those who had such insurance.
Cost-effective treatments are not used as often as they should be, while overutilization occurs with other health care services.
There are geographic variations in Medicare spending for patients in the last two years of life.
Higher spending did not result in patients living longer.
Many primary care physicians no longer see their patients while they are in the hospital; instead, hospitalists are used.
Insurance industry group America’s Health Insurance Plans estimates that administrative costs have averaged approximately 12% of premiums over the last 40 years, with costs shifting away from adjudicating claims and towards medical management, nurse help lines, and negotiating discounted fees with health care providers.
Coverage for large employers has the lowest administrative costs.
Most individuals pay for medical services largely through insurance, and this can distort the incentives of consumers since the consumer pays only a portion of the ultimate cost directly.
The lack of price information on US medical services can also distort incentives.
In 2020, 52.9 million adults were affected by mental illness, nearly one in five adults in the country.
Mental illnesses are the second leading cause of disability in the nation and affect 20% of all Americans.
It is estimated that less than half of all people with mental illnesses receive treatment due to factors such as stigma and lack of access to care
including a shortage of mental health professionals.
In the US, dental care is largely not recognized as healthcare, even though individuals visit a dentist more often than a general practitioner.
The magnitude of poor dental health i extensive: Seven out of ten older adults (aged >= 65) have periodontal disease, and one in four adults (aged > 65) has no teeth.
Older adults are more likely than those in younger age groups to have medical conditions, such as diabetes and cardiovascular disease, that worsen their oral health.
Health disparities are well documented in the U.S.: ethnic minorities such as African Americans, Native Americans, and Hispanics.
These minority groups have higher incidence of chronic diseases, higher mortality, poorer health outcomes and poorer rates of diagnosis and treatment.
The cancer incidence rate among African Americans, which is 25% higher than among whites.
In addition, adult African Americans and Hispanics have approximately twice the risk as whites of developing diabetes and have higher overall obesity rates.
Minorities also have higher rates of cardiovascular disease and HIV/AIDS than whites.
In the U.S., Asian Americans live the longest (87.1 years), followed by Latinos (83.3 years), whites (78.9 years), Native Americans (76.9 years), and African Americans (75.4 years).
Racial differences exist in healthy life expectancy at lower levels of education.
Public spending is highly correlated with age; average per capita public spending for seniors was more than five times that for children.
Seniors comprise 13% of the population but take 1/3 of all prescription drugs.
The average senior fills 38 prescriptions annually.
Minorities are not regularly screened for colon cancer and the death rate for colon cancer has increased among African Americans and Hispanic people.
Racism may underlie unexplained inequities in health care, including treatment for heart disease, renal failure,bladder cancer,and pneumonia.
Black Americans receive less health care than white Americans – particularly when the care involved expensive new technology.
But one recent study has found that when minority and white patients use the same hospital, they are given the same standard of care.
The Food and Drug Administration (FDA) is the primary institution tasked with the safety and effectiveness of human and veterinary drugs.
It also is responsible for making sure drug information is accurately and informatively presented to the public.
The FDA reviews and approves products and establishes drug labeling, drug standards, and medical device manufacturing standards.
The FDA sets performance standards for radiation and ultrasonic equipment.
FDA rules went into extending protection from lawsuits to pharmaceutical manufacturers, even if it was found that they submitted fraudulent clinical trial data to the FDA in their quest for approval.
Per capita, theU.S. spends more on pharmaceuticals than any other country, although expenditures on pharmaceuticals accounts for a smaller share (13%) of total health care costs compared to an OECD average of 18%.
Some 25% of out-of-pocket spending by individuals is for prescription drugs.
A study fou dthat between 1990 and 2016, prescription drug prices in the US increased by 277% while prescription drug prices increased by only 57% in the UK, 13 percent in Canada, and decreased in France and Japan.
U.S. drug prices are rising because U.S. consumers are effectively subsidizing costs which drug companies cannot recover from consumers in other countries.
The U.S., along with New Zealand, make up the only countries in the world that allows direct-to-consumer advertising of prescription drugs.
According to a 2020 study published Lancet, a single-payer universal healthcare system could save 68,000 lives and $450 billion in US national healthcare expenditure annually, while another 2022 study published in the PNAS, estimated that a universal healthcare system could have saved more than 338,000 lives during the COVID-19 pandemic in the United States from its start until March 2022.
The Affordable Care Act is a health care reform bill that was signed into law and includes a large number of health-related provisions, most of which included expanding Medicaid eligibility for people making up to 133% of federal poverty level (FPL) subsidizing insurance premiums for individuals and families making up to 400% of FPL and capping expenses from 2% to 9.8% of annual income.
For the first time, all health policies sold in the United States must cap an individual’s (or family’s) medical expenses out of pocket annually.
Other provisions include providing incentives for businesses to provide health care benefits, prohibiting denial of coverage and denial of claims based on pre-existing conditions, establishing health insurance exchanges, prohibiting insurers from establishing annual spending caps and support for medical research.
The costs of these provisions are offset by a variety of taxes, fees, and cost-saving measures, such as new Medicare taxes for high-income brackets, taxes on indoor tanning, cuts to the Medicare Advantage program in favor of traditional Medicare, and fees on medical devices and pharmaceutical companies; there is also a tax penalty for citizens who do not obtain health insurance unless they are exempt due to low income or other reasons.
The Congressional Budget Office estimates that the net effect (including the reconciliation act) will be a reduction in the federal deficit by $143 billion over the first decade.
After the act’self-reported coverage, health, and access to care improved significantly.
Those insured by Medicaid tend to report fair or poor health, as opposed to excellent or very good health.