“One explanation for the health disadvantage of the United States relative to other high-income countries might be deficiencies in health services. Although the United States is renowned for its leadership in biomedical research, its cutting-edge medical technology, and its hospitals and specialists, problems with ensuring Americans’ access to the system and providing quality care have been a long-standing concern of policy makers and the public (Berwick et al., 2008; Brook, 2011b; Fineberg, 2012). Higher mortality rates from diseases, and even from transportation-related injuries and homicides, may be traceable in part to failings in the health care system.

“The United States stands out from many other countries in not offering universal health insurance coverage. In 2010, 50 million people (16 percent of the U.S. population) were uninsured (DeNavas-Walt et al., 2011). Access to health care services, particularly in rural and frontier communities or disadvantaged urban centers, is often limited. The United States has a relatively weak foundation for primary care and a shortage of family physicians (American Academy of Family Physicians, 2009; Grumbach et al., 2009; Macinko et al., 2007; Sandy et al., 2009). Many Americans rely on emergency departments for acute, chronic, and even preventive care (Institute of Medicine, 2007a; Schoen et al., 2009b, 2011). Cost sharing is common in the United States, and high out-of-pocket expenses make health care services, pharmaceuticals, and medical supplies increasingly unaffordable (Commonwealth Fund Commission on a High Performance System, 2011; Karaca-Mandic et al., 2012). In 2011, one-third of American households reported problems paying medical bills (Cohen et al., 2012), a problem that seems to have worsened in recent years (Himmelstein et al., 2009). Health insurance premiums are consuming an increasing proportion of U.S. household income (Commonwealth Fund Commission on a High Performance System, 2011).

“Apart from challenges with access, many Americans do not experience optimal quality when they do receive medical care (Agency for Healthcare Research and Quality, 2012), a problem that health policy leaders, service providers, and researchers have been trying to solve for many years (Brook, 2011a; Fineberg, 2012; Institute of Medicine, 2001). In the United States, health care delivery (and financing) is deeply fragmented across thousands of health systems and payers and across government (e.g., Medicare and Medicaid) and the private sector, creating inefficiencies and coordination problems that may be less prevalent in countries with more centralized national health systems. As a result, U.S. patients do not always receive the care they need (and sometimes receive care they do not need): one study estimated that Americans receive only 50 percent of recommended health care services (McGlynn et al., 2003).”

Source: National Research Council (US); Institute of Medicine (US); Woolf SH, Aron L, editors. U.S. Health in International Perspective: Shorter Lives, Poorer Health. Washington (DC): National Academies Press (US); 2013. 4, Public Health and Medical Care Systems. Available from: https://www.ncbi.nlm.nih.gov/books/NBK154484/