United States of America

The USA has a complex mix of public and private insurance systems. The two largest government schemes are Medicare and Medicaid. Medicare is a federal programme covering those aged 65 and above, and others with particular conditions or disabilities. Entitlement and benefits are the same in all states. 

Medicaid is a joint federal/state programme with mandatory entitlement and benefits defined at the federal level and optional benefits decided by states. It covers low-income families, pregnant women and some disabled people. 

Private health insurance, offered through employers, is funded via employee and employer contributions. Individuals may also purchase directly from private health insurance companies. Insurers and hospitals negotiate reimbursement rates for services. Health insurance exchanges in several states, as well as at the federal level, provide a means to pool contributions to get better deals when purchasing health plans from private health insurers. Health professionals and other service providers are reimbursed primarily on a fee-for-service and per-capita basis within some integrated health delivery systems. Hospitals receive payments based on the resources a patient is expected to consume depending on their diagnosis and any procedure. 

At around 17% of GDP (around US$ 12,000 per person in 2023), the USA spends far more money on healthcare than any other country, both on an absolute and a per capita basis. The OECD average, for example, is 8.8%. Spending in the USA has grown more than six-fold since 1970, in terms of total, government and private spending and is largely accounted for by high prices of services and products. Nevertheless, about 1 in 10 people aged 18-64 remains uninsured, despite sharp declines in uninsurance rates due to reforms in the context of the Obama era Affordable Care Act, and health outcomes lag behind many wealthy countries. There are especially considerable challenges in providing access to care to minorities and marginalized communities, as well as individuals in remote and rural areas.