United States of America HiT (2020)

The US has multiple health insurance systems, with around one-tenth of the population uninsured

There is not a single U.S. health care system, but several systems that serve different segments of the population. Most Americans receive their coverage from private health insurance while two major federal government health insurance programmes, Medicare and Medicaid, offer coverage for seniors and some of the disabled, and healthcare services for some of the poor and near-poor, respectively. Nevertheless, and unusually for high-income countries, almost 10% of the population remains uninsured; although this is a large improvement from the 17% figure prior to the implementation of the major provisions of the Affordable Care Act in 2014.

Large portions of the population face cost barriers

Even among those with coverage, high out-of-pocket costs can be a barrier to receiving timely care and medications such as prescription drugs. Out-of-pocket payments per capita, namely direct payment by consumers for health services, as well as coinsurance, co-payments, and deductible amounts, have increased substantially in real terms in recent years.

Despite high levels of expenditure, health care outcomes are variable

The United States spends far more money on healthcare per head than any other country. Compared to other high-income countries, however, life expectancy in the United States is lower and mortality is higher. Moreover, international comparison shows a varied picture with respect to quality and outcomes - with very good indicators for some diseases (e.g. certain cancers) and poor ones for others (e.g. asthma). Other health care outcomes - including those that are strongly influenced by the health care system, such as mortality amenable to health care, are mixed at best. While it is difficult to determine the extent to which deficiencies are health-system related, there is little doubt that some of the problems with the US performance with respect to health outcomes are a result of poor access to care. With regard to health behaviours, the picture is again varied; the United States has been notably effective in reducing smoking rates but equally ineffective in grappling with nutritional health and obesity.