All you ever wanted to know about the US health system

The Observatory is publishing a new health system review on the United States as part of its Health Systems in Transition (HiT) series. This is the first time the US health system has been comprehensively reviewed according to an internationally stipulated and defined framework. Based on the same template that is used to describe health systems in Europe and other OECD countries, the report provides a good basis for factual comparison and performance assessment of the US health system in an international perspective.

With the adoption of the Patient Protection and Affordable Care Act (ACA) in 2010, the health system in the US is facing a period of massive change. Whereas the health system in the US should be rather thought of as multiple systems largely operating independently at both federal and state levels, it also shows a varied picture in terms of spending, coverage, quality and outcomes. Relying on a large and well trained health workforce, with a wide range of high-quality specialists and high-rank institutions, it achieves among the best medical outcomes for certain indications (e.g. specific cancers). But at the same time performance is rather poor in addressing some other diseases (e.g. asthma) or public health challenges (e.g. nutritional health and obesity). Also life expectancy is relatively lower and mortality higher than in other high-income countries, although it is unclear to what extent this can be linked to deficiencies in the health system.

Still, the main challenges remain the incomplete coverage of the population and the high levels of health expenditure. With the ACA, with many of its major provisions to be implemented in 2014, improved access to care is expected through subsidies for the uninsured to enable them to purchase private insurance, increased eligibility for Medicaid, and a greater protection for the insured. Also more funding has been released for primary care and public health programmes. Measures are taken to improve quality of care and to better control expenditure. Despite of the reform steps taken so far, consensus about how to balance large private sector development with government involvement in the health sector remains hard to achieve.