1.2 The U.S. Healthcare System
Anita Hedlund
Healthcare in the United States is complex. The United States has the third-largest population in the world after China and India (approximately 335 million people), yet it has the world’s highest healthcare expenditure. Rather than a nationalized healthcare system, in the United States, “there are multiple insurers and delivery systems that are often uncoordinated” (Rice et al., 2020, p. 29).
Most patients in the United States are either paying out-of-pocket for healthcare services or paying private healthcare insurance to assist in covering costs. Because of this model, and the high cost of healthcare, lack of insurance coverage is a major barrier to public health. About 10% of the U.S. population has no health insurance, not necessarily because of unemployment but because the cost of coverage is too high (Tolbert et al., 2022). Additionally, the Commonwealth Fund (2022) found that 43% of working adults were underinsured in 2022, meaning that they had some insurance but it was insufficient for their healthcare needs. This contrasts with countries such as the United Kingdom, Germany, Switzerland, France, and Singapore that use socialized medicine. Socialized medicine is a healthcare system in which medical and hospital care is funded by public resources, primarily through taxes. In socialized medicine, all healthcare, including the employment of healthcare workers, is run by the country’s government.
Rice et al. (2020) state that strengths of the U.S. healthcare system are a “large and well-trained health workforce and a wide range of high-quality medical specialists, as well as secondary and tertiary institutions, a robust health sector research program and . . . among the best medical outcomes in the world” (p. 333). However, it should be noted that even though some U.S. medical outcomes, such as the survival rate of certain cancers, are among the best in the world, other conditions, such as asthma, may have poorer outcomes. There is also inconsistency in managing health behaviors through public messaging, with the United States being “notably effective in reducing smoking rates but equally ineffective in grappling with nutritional health and obesity” (Rice et al., 2020, p. xxiii).
Sadly, although the United States has a well-educated workforce and high-tech equipment, its mortality rate is worse than that of other countries with similar offerings. The Population Health Forum (2019) points out that the United States is the richest yet sickest nation in the world, with the largest gap in health outcomes between the wealthy and the poor. As the healthcare system grapples with these gaps, healthcare professions will need to consider how to address health equity or, in other words, provide the necessary support to ensure all people can attain their highest level of health regardless of identity or background.
The Centers for Disease Control and Prevention (CDC, 2022b) have indicated that key lifestyle c