“The United States is a federal constitutional democracy, with decision-making authority divided between the federal government and the state governments. It includes 50 states; the District of Columbia, which is home to the seat of the federal government in Washington, DC; and several territories including Puerto Rico, Guam and the US Virgin Islands. Power is shared among three branches of government: the executive, legislative and judicial.”

Source: Rice T, Rosenau P, Unruh LY, Barnes AJ, van Ginneken E. United States of America: Health system review. Health Systems in Transition, 2020; 22(4): pp. i–441.

“The President of the United States is elected every four years and is limited to two four-year terms. Rather than elections being based on popular vote, the US uses the ‘Electoral College’. Each state, as well as the District of Columbia, has the same number of representatives in the Electoral College as the total number of representatives in Congress that they are assigned. With a few recent exceptions, the presidential candidate who receives the most popular votes in a state is given all the state’s vote in the Electoral College. As a result, occasionally the candidate who receives a plurality of the national popular vote does not win the presidency. This has occurred five times – three times in the nineteenth century and most recently in 2000 and 2016.

“The US Congress, the legislative branch of the federal government, comprises the Senate and the House of Representatives. The former contains two members per state (100 total) with a term of six years, and the latter 435 members allotted to the states based on their populations, with a term of two years. The judicial branch of the federal government includes the Supreme Court, which has nine members who are appointed for life, and various district (regional) and appeals courts. Each state has a popularly elected governor whose term, except in one state, is four years. Most states limit governors to two terms. All but one state have two elected legislative bodies.

“On a more local level, within states there are numerous county and city governments. While it is difficult to summarize the roles played by the different levels of government, the US Constitution enumerates specific responsibilities as being under the purview of the federal government, including war and defence and international and interstate commerce – but also other laws that are ‘necessary and proper’. In general, state and local governments have authority over such activities as children’s education, public safety / prosecution of crime and a host of other domains, including many public health activities. As discussed in Section 2.5.2, the states regulate the licensing of health professionals as well. There are also a number of areas in which the federal government and states share authority (road construction is one example). In the health area, the primary example is the Medicaid programme (described in Chapter 3), which provides health insurance to low-income individuals and families. Medicaid is jointly funded but is administered by states, which in turn must meet certain federal requirements.”

Source: Rice T, Rosenau P, Unruh LY, Barnes AJ, van Ginneken E. United States of America: Health system review. Health Systems in Transition, 2020; 22(4): pp. i–441.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

Page last updated Oct. 19, 2022 by Doug McVay, Editor.