Overview

Key points

• The United States does not have a single health system; rather, residents obtain health insurance from several different public and private programmes, each with different eligibility criteria, benefit structures and provider payment mechanisms.
• Successes include a large and well trained health workforce, a wide range of high-quality secondary and tertiary institutions, a robust health sector research programme and, for selected services like certain cancers, among the best medical outcomes in the world.
• Major shortcomings include incomplete coverage and inadequate care for the uninsured, substantial financial access barriers even for those with coverage, extremely high health expenditure levels, poor health outcomes and an unequal distribution of resources and outcomes among different population groups.
• The US rate of 4.7 infant deaths per 1000 live births in 2019 exceeded every OECD European country except Türkiye. There are striking differences in the United States by race and ethnicity, with the infant death rate for non-Hispanic Blacks more than double the rate for non-Hispanic Whites, and triple the rate for non-Hispanic Asians.
• Because a myriad of cultural, socioeconomic and environmental factors affects health status, it is difficult to know which deficiencies in outcomes are health system-related. Nevertheless, since mortality rates from treatable causes exceed those in comparator countries, there is evidence that the problems are related to the health system.
• The US health system faces many challenges to maintaining and building resilience. Areas needing strengthening include reducing poverty and inequality, achieving universal health insurance, strengthening the public health system, and retaining health professionals by improving their working conditions.