Main description:

This analysis of the United States health care system reviews developments in organization and governance, health financing, health care provision, health reforms, and health system performance. The U.S. system has both considerable strengths and notable weaknesses. It has a large and well-trained health workforce, a wide range of high-quality medical specialists as well as secondary and tertiary institutions, a robust health sector research program, and, for selected services, among the best medical outcomes in the world. But it also suffers from incomplete coverage of its citizenry, health expenditure levels per person far exceeding all other countries, poor objective and subjective indicators of quality and outcomes, and an unequal distribution of resources and outcomes across the country and among different population groups. Because of the adoption of the Affordable Care Act in 2010, and subsequent revisions to it, the U.S. is facing a period of enormous change. There is a great need to improve coverage and improve equity, better ensure quality outcomes, and find ways to better control expenditures. Health Systems in Transition: USA provides an in-depth discussion of these issues and a thorough review of the U.S. health care system.

Contents:

Preface
Acknowledgements
List of abbreviations
List of tables, figures and boxes
Abstract
Executive summary

1 Introduction
1.1 Geography and sociodemography
1.2 Economic context
1.3 Political context
1.4 Health status

2 Organization and governance
2.1 Historical background
2.2 Organization of the healthcare system
2.3 Decentralization and centralization
2.4 Planning
2.5 Intersectorality
2.6 Patient empowerment
2.7 Regulation

3 Financing
3.1 Health expenditure
3.2 Sources of revenue, financing and financial flows
3.3 Medicare
3.4 Medicaid
3.5 Private health insurance
3.6 Out-of-pocket payments
3.7 Payment mechanisms

4 Physical and human resources
4.1 Physical resources
4.2 Human resources

5 Provision of services
5.1 Patient pathways
5.2 Public health
5.3 Outpatient services: primary care
5.4 Outpatient services: specialty care
5.5 Other outpatient services: ambulatory surgical, emergency and urgent care
5.6 Acute inpatient care
5.7 Dental care
5.8 Behavioural healthcare
5.9 Pharmaceutical care
5.10 Post-acute care: rehabilitation, intermittent home care and subacute care
5.11 Long-term care
5.12 Palliative care
5.13 Services from informal care-givers
5.14 Racial and ethnic minorities, low-income individuals, the uninsured and other vulnerable populations

6 Principal health reforms
6.1 History of US health reforms
6.2 The Affordable Care Act
6.3 The future of the ACA

7 Assessment of the health system
7.1 Health system governance
7.2 Accessibility
7.3 Financial protection
7.4 Healthcare quality
7.5 Health outcomes
7.6 Health system efficiency

8 Conclusions
9 Appendices
9.1 References
9.2 Useful websites
9.3 HiT methodology and production process
9.4 About the authors