Health Care Utilization and Expenditures
The U.S. health care system is unique among industrialized nations because it lacks a national health insurance program. The United States relies instead on private health insurance that individuals or companies must purchase. The public insurance system is limited to those who are aged or disabled (Medicare) and to some individuals who are poor (Medicaid). The delivery system for health care in the United States is almost entirely private, with only a small sector of government providers who primarily target the poor and uninsured population. Moreover, the U.S. health care system is largely unplanned and has limited regulation, even though the government is a large payer of services. In contrast, other industrialized nations have national health systems that provide coverage for their populations that are generally independent of employment (Blendon et al. 1995). These systems are more comprehensive and less expensive than the U.S. system, which excludes 43 million people (U.S. Bureau of the Census 1998b). This article examines the factors that have contributed to a system that severely limits access to millions of individuals in the United States.
We first examine health care utilization and expenditure patterns at the macro level. This approach is used by public policy makers at the federal, state, and local levels and by private insurers in decision making about the allocation and control of public and private resources for health care services.
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