International comparison shows a varied picture with respect to access to health care, health behaviors, and outcomes. The USA spends far more money on health care per person than any other country. The US health-care system reflects this wider context, having developed largely through the private sector and combining high levels of spending with distinctively low levels of government regulation. Historically, the USA has resisted central planning or control at both the federal and state levels. In California, there are now almost twice as many Hispanics and Latinos age 18 and younger than there are whites ( 2015). Hispanics and Latinos are the fastest-growing group, with a 49% population increase between 20, compared to just 5% for others (Ennis et al. The racial and ethnic makeup of the US population is quite varied, with approximately 64% non-Hispanic White, 16% Hispanic or Latino, 13% non-Hispanic Black or African American, and the remainder other and/or mixed racial and ethnic groups (US Census Bureau 2014).
Because the US birth rate is higher than that of most developed countries, its dependency ratio – those too young or too old to work, divided by the working age population – is expected to grow more slowly than in most other countries. Despite being a high-income nation, the USA ranks poorly, compared to other high-income countries, on measures of income equality. Tax rates are lower than in almost all other high-income countries, consistent with the fact that its public sector provides fewer social services. As with many such national averages in this report, there are wide variations across the states, with spending per capita in 2009 ranging from about $5,000 per person in Utah to more than $10,000 in the District of Columbia (Kaiser Family Foundation 2009). In 2013 nearly one-fifth (17.4%) of its economy was spent on health care, amounting to $9,255 per person (Hartman et al. It is a federal constitutional democracy, with decision-making authority divided between the federal and state governments. The USA is a large, wealthy country, with double gross domestic product of any other in the world. This process is experimental and the keywords may be updated as the learning algorithm improves. These keywords were added by machine and not by the authors.
Whether the ACA will be effective in addressing the US health-care system’s historic challenges can only be determined over time. Furthermore, primary care and public health are receiving increased funding, and improving quality and controlling expenditures are addressed through a range of policies. Eligibility for Medicaid, which provides public coverage for low-income individuals and families, is also expanded and greater protections for insured persons have been instituted. Improving coverage is a central aim, envisaged through mandates that certain individuals purchase and employers offer private health insurance as well as subsidies for lower-income uninsured citizens to purchase private insurance. The major provisions of the ACA were implemented in 2014, although judicial setbacks and delays will reduce its overall impact. Because of the adoption of the Affordable Care Act (ACA) in 2010, the USA is facing a period of enormous potential change.
It is difficult to determine the extent to which deficiencies are health system related, though it seems that at least some of the problems are a result of poor access to care. But it also suffers from incomplete coverage of its citizenry, health expenditure levels per person far exceeding all other countries, poor data on many objective and subjective measures of quality and outcomes, an unequal distribution of resources and outcomes across the country and among different population groups, and lagging efforts to introduce health information technology. It has a large and well-trained health workforce, a wide range of high-quality medical specialists as well as secondary and tertiary institutions, and a robust health research program and, for selected services, has among the best medical outcomes in the world. The US health system has both considerable strengths and notable weaknesses. This analysis of the US health system reviews its organization and governance, health financing, health-care provision, health reforms, and health system performance.
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