U.s.health care system overview1/6/2024 The pricing of health care goods and services is substantially higher in the United States than in other developed nations. Japan, the Organization for Economic Cooperation and Development (OECD) country most similar in population size to the United States (127.7 and 327.2 million, respectively), spends less than half per capita on health care as the United States, averaging $4717 per person annually ( 11, 12). Hospital services accounted for 33% of spending, physician and clinical services for 20%, prescription drugs for 9%, and other professional services for 3% ( 10). In 2018, nearly 18% of the nation's gross domestic product-$3.6 trillion-was directed to health care. The United States spends far more per capita on health care than other wealthy countries, and spending is increasing at an unsustainable rate ( 8, 9). Health Care Spending Is High and Unsustainable Yet, the ACA remains politically contentious and has been subject to numerous repeal attempts, court challenges, and regulatory changes that may undermine its effectiveness and viability. The ACP has offered recommendations for improving the ACA's coverage provisions ( 7). Supreme Court decision that made expansion optional ( 6). In part, this is the result of congressional policy decisions, including the prohibition on premium tax credits to undocumented immigrants and limiting eligibility for premium tax credits and cost-sharing reduction assistance to people with incomes under 400% of the federal poverty level (FPL), as well as some states' decisions not to broaden Medicaid eligibility after a 2012 U.S. The Patient Protection and Affordable Care Act of 2010 (ACA) led to historic reductions in the number of uninsured persons, yet nearly 30 million remain uninsured, millions more are underinsured, and the number of uninsured persons is expected to grow ( 4, 5). The United States is the only wealthy industrialized nation without universal health coverage, a crucial component to ensuring quality health care for all without financial burden that causes delay or avoidance of necessary medical care. Too Many Americans Are Uninsured or Underinsured The ACP operating budget was the sole source of funding for the development of this position paper. The position paper and related recommendations were reviewed and approved by the Health and Public Policy Committee in July 2019 and the Board of Regents on 2 November 2019. On the basis of this review, the Committee drafted recommendations with input from the ACP's Board of Governors, Board of Regents, Council of Early Career Physicians, Council of Resident/Fellow Members, Council of Student Members, and Council of Subspecialty Societies. Sources published before 2009 were largely excluded, with the exception of contextual resources and references to ACP policy papers. The Committee reviewed available studies, reports, and surveys on health care coverage options and the cost of health care in the United States, identified by searching PubMed, Google Scholar, news articles, policy documents, proposals for coverage expansion, and other sources. public and the practice of internal medicine and its subspecialties, drafted this paper. The Health and Public Policy Committee of the ACP, which is charged with addressing issues that affect the health care of the U.S. Part 3 describes how an emphasis on value-based care can reduce costs. Part 2 presents 2 potential approaches to achieve universal coverage. Part 1 of this paper discusses why the United States needs to do better in addressing coverage and cost. Major changes are needed to a system that costs too much, leaves too many behind, and delivers too little. Administrative barriers divert time from patient care and frustrate patients, clinicians, and policymakers. The United States spends far more on health care administration than peer countries. public insurance programs is a perennial concern. Employer-sponsored insurance is less prevalent and more expensive than in the past, and in response, deductibles have grown and benefits have been cut. Many Americans cannot afford health insurance, and even those with insurance face substantial cost-related barriers to care. Although the United States leads the world in health care spending, it fares far worse than its peers on coverage and most dimensions of value.
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