overview

The USA government is a federal system. Federal government power is defined and limited by the Constitution, with health and education falling within the control of the States, resulting in considerable diversity.

The United States does not have a universal health care system although a majority of its citizens have some sort of healthcare coverage. Primary Health Care is run through private enterprise with a major role played by insurance companies and managed care organisations which provide subscribed individuals access to their network of employed or contracted physicians and of healthcare services.

In order to provide a safety net, the US purchases health insurance (Medicare) on behalf of those over 65 who have worked for at least 10 years in Medicare covered employment and those with specified illnesses or disabilities. The US Government also administers Medicaid which provides insurance for low income people who meet stringent eligibility requirements, purchases health insurance on behalf of government employees and the military and runs a health care system for military veterans. In addition, the Indian Health Service provides federally funded health services to over half the Native American and Native Alaskan populations. Some states are attempting to implement universal health insurance coverage. Other states provide supplementary funding for hospitals and providers are funded to cover healthcare expenses for the uninsured.

The shape of the health system is a result of market forces rather than government led reforms. The market approach results in underinsurance, poor population health, and healthcare disparities. Moreover, capital investment is directed at delivering high-end lucrative products and services, rather than improving health outcomes.