Professional Documents
Culture Documents
See also: Health care reform in the United States, Patient or Scotland.[11][12] A study showed that the U.S., Japan,
Protection and Aordable Care Act and Health Care and France recorded the highest survival rates among 31
and Education Reconciliation Act of 2010
nations for four types of cancer.[13]
America is a global leader in medical innovation. The US
solely developed or contributed signicantly to 9 of the
top 10 most important medical innovations since 1975
as ranked by a 2001 poll of physicians, while the EU
and Switzerland together contributed to ve. Since 1966,
Americans have received more Nobel Prizes in Medicine
than the rest of the world combined. From 1989 to 2002,
four times more money was invested in private biotechnology companies in America than in Europe.[14][15] The
United States also has the most advanced hospitals in the
[16]
6065% of healthcare provision and spending comes world.
from programs such as Medicare, Medicaid, the Gallup recorded that the uninsured rate among U.S.
Childrens Health Insurance Program, and the Veterans adults was 11.9% for the rst quarter of 2015, continuing
Health Administration. Most of the population under 67 the decline of the uninsured rate outset by the Aordis insured by their or a family members employer, some able Care Act.[17] A 2004 Institute of Medicine (IOM)
buy health insurance on their own, and the remainder are report said: The United States is among the few indusuninsured. Health insurance for public sector employees trialized nations in the world that does not guarantee acis primarily provided by the government.
cess to health care for its population. A 2004 OECD reThe United States life expectancy of 78.4 years at birth, port said: With the exception of Mexico, Turkey, and
up from 75.2 years in 1990, ranks it 50th among 221 na- the United States, all OECD countries had achieved unitions, and 27th out of the 34 industrialized OECD coun- versal or near-universal (at least 98.4% insured) coverage
tries, down from 20th in 1990.[3][4] Of 17 high-income of their populations by 1990. Recent evidence demoncountries studied by the National Institutes of Health in strates that lack of health insurance causes some 45,000
unnecessary deaths every year in the United
2013, the United States had the highest or near-highest to 48,000
[18][19]
States.
In 2007, 62.1% of lers for bankruptcies
prevalence of obesity, car accidents, infant mortality,
claimed
high
medical
expenses. A 2013 study found that
heart and lung disease, sexually transmitted infections,
about
25%
of
all
senior
citizens declare bankruptcy due
adolescent pregnancies, injuries, and homicides. On avto
medical
expenses,
and
43% are forced to mortgage or
erage, a U.S. male can be expected to live almost four
[20]
sell
their
primary
residence.
fewer years than those in the top-ranked country, though
Health care in the United States is provided by many
distinct organizations.[1] Health care facilities are largely
owned and operated by private sector businesses. 58%
of US community hospitals are non-prot, 21% are government owned, and 21% are for-prot.[2] According to
the World Health Organization (WHO), the United States
spent more on health care per capita ($8,608), and more
on health care as percentage of its GDP (17.2%), than
any other nation in 2011.
notably Americans aged 75 live longer than those who On March 23, 2010, the Patient Protection and Aordreach that age in other developed nations.[5]
able Care Act (PPACA) became law, providing for major
in health insurance. The medical system will be
changes
A comprehensive 2007 study by European doctors found
forced
to
change normal procedures.[1] They will be rethe ve-year cancer survival rate was signicantly higher
quired to prepare for upcoming programs to meet federal
in the U.S. than in all 21 European nations studied, 66.3%
[21]
for men versus the European mean of 47.3% and 62.9% regulations. The constitutionality of the law, as well as
its impact on insurance coverage, insurance quality, inversus 52.8% for women.[6][7] Americans undergo canquality, and the economy are
cer screenings at signicantly higher rates than people surance premiums, medical[22]
subjects of ongoing debate.
in other developed countries, and access MRI and CT
scans at the highest rate of any OECD nation.[8] People in
the U.S. diagnosed with high cholesterol or hypertension
access pharmaceutical treatments at higher rates than
those diagnosed in other developed nations, and are 1 History
more likely to successfully control the conditions.[9][10]
Diabetics are more likely to receive treatment and meet
treatment targets in the U.S. than in Canada, England, Main article: History of medicine in the United States
2 STATISTICS
dierent. 53% of women who die before 50 die due
to disease, whereas 38% die due to accidents, homicide,
and suicide.[24] However maternal deaths related to childbirth have increased. In 2013 18.5 mothers died for every 100,000 births. In 1987 the mortality rate was 7.2 per
100,000. The American rate is now more than double the
maternal mortality rate in Saudi Arabia and Canada, and
more than triple the rate in the United Kingdom.[25]
A study by the Agency for Healthcare Research and Quality (AHRQ) found that there were 38.6 million hospital
stays in the U.S. in 2011, an 11 percent increase since
1997. Since the population also grew during this period,
the hospitalization rate remained stable at approximately
1,200 stays per 10,000 population.[26]
Statistics
The U.S. Census Bureau reported that 49.9 million residents, 16.3% of the population, were uninsured in 2010
(up from 49.0 million residents, 16.1% of the population,
in 2009).[27][28] According to the World Health Organization (WHO), the United States spent more on health
care per capita ($7,146), and more on health care as percentage of its GDP (15.2%), than any other nation in
2008.[29] The United States had the fourth highest level of
government health care spending per capita ($3,426), behind three countries with higher levels of GDP per capita:
Monaco, Luxembourg, and Norway.[29] A 2001 study in
ve states found that medical debt contributed to 46.2%
of all personal bankruptcies and in 2007, 62.1% of lers for bankruptcies claimed high medical expenses.[30]
Since then, health costs and the numbers of uninsured
and underinsured have increased.[31] A 2013 study found
that about 25% of all senior citizens declare bankruptcy
due to medical expenses.[20]
3.2
seeking greater government involvement in US healthcare, then led by former Carter administration ocial
Karen Davis,[39] ranked the United States last in the quality of health care among similar countries,[40] and notes
U.S. care costs the most.[41]
3
pitals as well as government hospitals in some locations,
mainly owned by county and city governments. The HillBurton Act was passed in 1946, which provided federal funding for hospitals in exchange for treating poor
patients.[49]
pected to live six months or less are most commonly subsidized by charities and government. Prenatal, family
planning, and dysplasia clinics are government-funded
obstetric and gynecologic specialty clinics respectively,
On March 23, 2010, the Patient Protection and Aord- and are usually staed by nurse practitioners.
able Care Act (PPACA) became law, providing for major
changes in health insurance.
Providers
Health care providers in the U.S. encompass individual Main article: Physician in the United States
health care personnel, health care facilities and medical
products.
Physicians in the U.S. include those trained by the U.S.
medical education system, and those that are international
medical graduates who have progressed through the nec3.1 Facilities
essary steps to acquire a medical license to practice in a
state.
Main article: Medical centers in the United States
The American College of Physicians, uses the term physician to describe all medical practitioners holding a proIn the U.S., ownership of the health care system is mainly fessional medical degree. In the U.S., however, most
in private hands, though federal, state, county, and city physicians have either an Doctor of Medicine (M.D.) or
governments also own certain facilities.
a Doctor of Osteopathic Medicine (D.O.) degree. The
The non-prot hospitals share of total hospital ca- American Medical Association as well as the American
pacity has remained relatively stable (about 70%) for Osteopathic Association both currently use the term
decades.[48] There are also privately owned for-prot hos- physician to describe members.
3.3
4 SPENDING
Medical products, research and devel- fastest growing health sectors (such as seniors home care)
are also some of the lowest paid which could cause supply
opment
According to the World Health Organization (WHO), total health care spending in the U.S. was 17.9% of its GDP
in 2011, the highest in the world.[29] The Health and Human Services Department expects that the health share
of GDP will continue its historical upward trend, reaching 19.5% of GDP by 2017.[63][64] Of each dollar spent
on health care in the United States, 31% goes to hospital care, 21% goes to physician/clinical services, 10% to
pharmaceuticals, 4% to dental, 6% to nursing homes and
3% to home health care, 3% for other retail products, 3%
for government public health activities, 7% to administrative costs, 7% to investment, and 6% to other professional
services (physical therapists, optometrists, etc.).[65]
Around 84.7% of Americans have some form of health
insurance; either through their employer or the employer
of their spouse or parent (59.3%), purchased individually
(8.9%), or provided by government programs (27.8%;
there is some overlap in these gures).[66] All government
health care programs have restricted eligibility, and there
is no government health insurance company which covers
all Americans. Americans without health insurance coverage in 2007 totaled 15.3% of the population, or 45.7
million people.[66]
Among those whose employer pays for health insurance,
the employee may be required to contribute part of the
cost of this insurance, while the employer usually chooses
the insurance company and, for large groups, negotiates
5.1
with the insurance company. Government programs directly cover 27.8% of the population (83 million),[66] including the elderly, disabled, children, veterans, and some
of the poor, and federal law mandates public access to
emergency services regardless of ability to pay. Public
spending accounts for between 45% and 56.1% of U.S.
health care spending.[67]
5.2
mechanism for such care. Indirect payments and reimbursements through federal and state government programs have never fully compensated public and private
hospitals for the full cost of care mandated by EMTALA.
More than half of all emergency care in the U.S. now goes
uncompensated.[79] According to some analyses, EMTALA is an unfunded mandate that has contributed to
nancial pressures on hospitals in the last 20 years, causing them to consolidate and close facilities, and contributing to emergency room overcrowding. According to the
Institute of Medicine, between 1993 and 2003, emergency room visits in the U.S. grew by 26%, while in the
same period, the number of emergency departments declined by 425.[80]
Quality assurance
6.2
7
The underutilization of preventative measures, rates
of preventable illness and prevalence of chronic
disease suggest that the US healthcare system
does not suciently promote wellness.[85] Over
the past decade rates of teen pregnancy and low
birth rates have come down signicantly, but not
disappeared.[94] Rates of obesity, heart disease (high
blood pressure, controlled high cholesterol), and diabetes are areas of major concern. While chronic
disease and multiple co-morbidities became increasingly common among a population of elderly Americans who were living longer, the public health system has also found itself fending o a rise of chronically ill younger generation. According to the
US Surgeon General The prevalence of obesity in
the U.S. more than doubled (from 15% to 34%)
among adults and more than tripled (from 5% to
17%) among children and adolescents from 1980 to
2008.[95]
A concern for the health system is that the health
gains do not accrue equally to the entire population.
In the United States, disparities in health care and
health outcomes are widespread.[96] Minorities are
more likely to suer from serious illnesses (e.g., diabetes, heart disease and colon cancer) and less likely
to have access to quality health care, including preventative services.[97] Eorts are underway to close
the gap and to provide a more equitable system of
care.
6.1.3 Innovation: Workforce, healthcare IT, R&D
Finally, the United States tracks investment in the healthcare system in terms of a skilled healthcare workforce,
meaningful use of healthcare IT, and R&D output. This
aspect of the healthcare system performance dashboard
is important to consider when evaluating cost of care in
America. That is because in much of the policy debate around the high cost of US healthcare, proponents
of highly specialized and cutting edge technologies point
to innovation as a marker of an eective health care
Population health: Quality, prevention, vulsystem.[98]
nerable populations
The health of the population is also viewed as a measure 6.2 Compared to other countries
of the overall eectiveness of the healthcare system. The
extent to which the population lives longer healthier lives A 2014 study by the private American foundation The
signals an eective system.
Commonwealth Fund found that although the U.S. health
care system is the most expensive in the world, it ranks
While life expectancy is one measure, HHS uses a last on most dimensions of performance when compared
composite health measure that estimates not only with Australia, Canada, France, Germany, the Netherthe average length of life, but also, the part of life lands, New Zealand, Norway, Sweden, Switzerland and
expectancy that is expected to be in good or better the United Kingdom. The study found that the United
health, as well as free of activity limitations. Be- States failed to achieve better outcomes than other countween 1997 and 2010, the number of expected high tries, and is last or near last in terms of access, equality life years increased from 61.1 to 63.2 years ciency and equity. Study date came from international
surveys of patients and primary care physicians, as well
for newborns.[93]
as information on health care outcomes from The Commonwealth Fund, the World Health Organization, and
the Organization for Economic Cooperation and Development.[100][101]
The U.S. stands 50th in the world with a life expectancy
of 78.49.[102] The CIA World Factbook ranked the
United States 174th worst (out of 222) meaning 48th
best in the world for infant mortality rate (5.98/1,000
live births).[103]
A study found that between 1997 and 2003, preventable
deaths declined more slowly in the United States than in
18 other industrialized nations.[104] A 2008 study found
that 101,000 people a year die in the U.S. that would not if
the health care system were as eective as that of France,
Japan, or Australia.[105]
The Organisation for Economic Co-operation and Development (OECD) found that the U.S. ranked poorly in
terms of years of potential life lost (YPLL), a statistical measure of years of life lost under the age of 70 that
were amenable to being saved by health care. Among
OECD nations for which data are available, the United
States ranked third last for the health care of women (after Mexico and Hungary) and fth last for men (Slovakia
and Poland also ranked worse).
Further information: Years of potential life lost
Recent studies nd growing gaps in life expectancy based
on income and geography. In 2008, a governmentsponsored study found that life expectancy declined from
1983 to 1999 for women in 180 counties, and for men
in 11 counties, with most of the life expectancy declines
occurring in the Deep South, Appalachia, along the Mississippi River, in the Southern Plains and in Texas. The
7.1
Eciency
The authors note that the increase in babies born with low standardized death rate. The US dropped from 23rd to
birth weights can be attributed to women delaying child- 28th for age-standardized years of life lost. It dropped
bearing and the increased use of fertility drugs.[115][116]
from 20th to 27th in life expectancy at birth. It dropped
[4]
In a sample of 13 developed countries the USA was from 14th to 26th for healthy life expectancy.
third in its population weighted usage of medication in
14 classes in both 2009 and 2013. The drugs studied
were selected on the basis that the conditions treated had
high incidence, prevalence and/or mortality, caused signicant long-term morbidity and incurred high levels of
expenditure and signicant developments in prevention
or treatment had been made in the last 10 years. The
study noted considerable diculties in cross border comparison of medication use.[117]
7.1
7.1.1
Eciency
Preventable deaths
According to a 2009 study conducted at Harvard Medical School by co-founders of Physicians for a National
Health Program, a pro-single payer lobbying group, and
published by the American Journal of Public Health, lack
of health coverage is associated with nearly 45,000 excess preventable deaths annually.[18][122] Since then, as
the number of uninsured has risen from about 46 million in 2009 to 48.6 million in 2012, the number of preventable deaths due to lack of insurance has grown to
about 48,000 per year.[19] The groups methodology has
been criticized by economist John C. Goodman for not
looking at cause of death or tracking insurance status
changes over time, including the time of death.[46]
A 2009 study by former Clinton policy adviser Richard
Kronick published in the journal Health Services Research found no increased mortality from being uninsured
after certain risk factors were controlled for.[47]
7.1.2 Value for money
A study of international health care spending levels published in the health policy journal Health Aairs in the
year 2000 found that the United States spends substantially more on health care than any other country in the
Organization for Economic Co-operation and Development (OECD), and that the use of health care services
in the U.S. is below the OECD median by most measures. The authors of the study conclude that the prices
paid for health care services are much higher in the U.S.
than elsewhere.[123] While the 19 next most wealthy countries by GDP all pay less than half what the U.S. does for
health care, they have all gained about six years of life
expectancy more than the U.S. since 1970.[99]
7.1.3 Delays in seeking care and increased use of
emergency care
Uninsured Americans are less likely to have regular health
care and use preventive services. They are more likely
to delay seeking care, resulting in more medical crises,
which are more expensive than ongoing treatment for
such conditions as diabetes and high blood pressure. A
2007 study published in JAMA concluded that uninsured
people were less likely than the insured to receive any
medical care after an accidental injury or the onset of
a new chronic condition. The uninsured with an injury were also twice as likely as those with insurance to
have received none of the recommended follow-up care,
and a similar pattern held for those with a new chronic
condition.[124] Uninsured patients are twice as likely to
visit hospital emergency rooms as those with insurance;
burdening a system meant for true emergencies with less-
10
7.1.4
7.2
11
Overall costs
The U.S. spends more as a percentage of GDP than similar countries, and this can be explained either through
higher prices for services themselves, higher costs to administer the system, or more utilization of these services,
or to a combination of these elements.[153]
Free-market advocates claim that the health care system is dysfunctional because the system of third-party
payments from insurers removes the patient as a major
participant in the nancial and medical choices that af-
12
7.4 Equity
7.4.1 Coverage
fect costs. The Cato Institute claims that because government intervention has expanded insurance availability
through programs such as Medicare and Medicaid, this
has exacerbated the problem.[154] According to a study
paid for by Americas Health Insurance Plans (a Washington lobbyist for the health insurance industry) and carried out by PriceWaterhouseCoopers, increased utilization is the primary driver of rising health care costs in the
U.S.[155] The study cites numerous causes of increased
utilization, including rising consumer demand, new treatments, more intensive diagnostic testing, lifestyle factors,
the movement to broader-access plans, and higher-priced
technologies.[155] The study also mentions cost-shifting
from government programs to private payers. Low reimbursement rates for Medicare and Medicaid have increased cost-shifting pressures on hospitals and doctors,
who charge higher rates for the same services to private payers, which eventually aects health insurance
rates.[156]
States like California oer insurance coverage for children of low income families, but not for adults; other
states do not oer such coverage at all: both parent and child are caught in the notorious coverage
gap. Although EMTALA[161] certainly keeps alive
many working-class people who are badly injured, the
1986 law neither requires the provision of preventive or
rehabilitative care, nor subsidizes such care, and it does
Health care costs rising far faster than ination have been nothing about the diculties in the American mental
a major driver for health care reform in the United States. health system.
Surgical, injury, and maternal and neonatal health hospi- Coverage gaps also occur among the insured population.
tal visit costs increased by more than 2% each year from Johns Hopkins University professor Vicente Navarro
2003-2011. Further, while average hospital discharges stated in 2003, the problem does not end here, with the
remained stable, hospital costs rost from $9,100 in 2003 uninsured. An even larger problem is the underinsured"
7.4
Equity
and The most credible estimate of the number of people in the United States who have died because of lack
of medical care was provided by a study carried out
by Harvard Medical School Professors Himmelstein and
Woolhandler.[162] They concluded that almost 100,000
people died in the U.S. yearly because of lack of needed
care.[163] Another study by the Commonwealth Fund
published in Health Aairs estimated that 16 million U.S.
adults were underinsured in 2003. The study dened
underinsurance as characterized by at least one of the
following conditions: annual out-of-pocket medical expenses totaling 10% or more of income, or 5% or more
among adults with incomes below 200% of the federal
poverty level; or health plan deductibles equaling or exceeding 5% of income. The underinsured were signicantly more likely than those with adequate insurance to
forgo health care, report nancial stress because of medical bills, and experience coverage gaps for such items
as prescription drugs. The study found that underinsurance disproportionately aects those with lower incomes 73% of the underinsured in the study population had annual incomes below 200% of the federal poverty level.[164] Another study focusing on the
eect of being uninsured found that individuals with
private insurance were less likely to be diagnosed with
late-stage cancer than either the uninsured or Medicaid
beneciaries.[126] A study examining the eects of health
insurance cost-sharing more generally found that chronically ill patients with higher co-payments sought less care
for both minor and serious symptoms while no eect on
self-reported health status was observed. The authors
concluded that the eect of cost sharing should be carefully monitored.[165]
Coverage gaps and aordability also surfaced in a 2007
international comparison by the Commonwealth Fund.
Among adults surveyed in the U.S., 37% reported that
they had foregone needed medical care in the previous
year because of cost; either skipping medications, avoiding seeing a doctor when sick, or avoiding other recommended care. The rate was higher 42% among
those with chronic conditions. The study reported that
these rates were well above those found in the other six
countries surveyed: Australia, Canada, Germany, the
Netherlands, New Zealand, and the UK.[166] The study
also found that 19% of U.S. adults surveyed reported serious problems paying medical bills, more than double
the rate in the next highest country.
7.4.2
Mental health
13
in the nation and aect 20% of all Americans.[167] It
is estimated that less than half of all people with mental illnesses receive treatment (or specically, an ongoing, much needed, and managed care; where medication
alone, cannot easily remove mental conditions) due to
factors such as stigma and lack of access to care.[168]
The Paul Wellstone Mental Health and Addiction Equity
Act of 2008 mandates that group health plans provide
mental health and substance-related disorder benets that
are at least equivalent to benets oered for medical and
surgical procedures. The legislation renews and expands
provisions of the Mental Health Parity Act of 1996. The
law requires nancial equity for annual and lifetime mental health benets, and compels parity in treatment limits
and expands all equity provisions to addiction services.
Insurance companies and third-party disability administrators (most notably, Sedgwick CMS) used loopholes
and, though providing nancial equity, they often worked
around the law by applying unequal co-payments or setting limits on the number of days spent in inpatient or
outpatient treatment facilities.[169][170]
14
those were oered standard rates. Seventy percent of applicants age 6064 were oered coverage, but almost half
the time (40%) it was at an increased premium. The study
did not address how many applicants who were oered
coverage at increased rates chose to decline the policy.
A study conducted by the Commonwealth Fund in 2001
found that, among those aged 19 to 64 who sought individual health insurance during the previous three years,
the majority found it unaordable, and less than a third
ended up purchasing insurance. This study did not distinguish between consumers who were quoted increased
rates due to medical underwriting and those who qualied for standard or preferred premiums.[177] Some states
have outlawed medical underwriting as a prerequisite for
individually purchased health coverage.[178] These states
tend to have the highest premiums for individual health
insurance.[179]
9.2
Debate
On March 4, 2009, an important U.S. Supreme Court decision was handed down. In Wyeth v. Levine, the court
asserted that state-level rights of action could not be preempted by federal immunity and could provide appropriate relief for injured consumers.[199] In June 2009,
under the Public Readiness and Emergency Preparedness
Act, Secretary of Health and Human Services Kathleen
Sebelius signed an order extending protection to vaccine
makers and federal ocials from prosecution during a
declared health emergency related to the administration
of the swine u vaccine.[200][201]
8.1
15
companies would earn in an open market versus what they
are earning now) to drug companies or to the U.S. government. In turn, pharmaceutical companies would be
able to continue to produce innovative pharmaceuticals
while lowering prices for U.S. consumers. Currently, the
U.S., as a purchaser of pharmaceuticals, negotiates some
drug prices but is forbidden by law from negotiating drug
prices for the Medicare program due to the Medicare
Prescription Drug, Improvement, and Modernization Act
passed in 2003. Democrats have charged that the purpose of this provision is merely to allow the pharmaceutical industry to proteer o of the Medicare program,
which is already in imminent danger of becoming nancially insolvent.[207]
16
fect their health. For virtually every subjective and objective measure of their health status, the self-employed
and wage-earners are statistically indistinguishable for
each other.[211] Both sides of the political spectrum have
also looked to more philosophical arguments, debating
whether people have a fundamental right to have health
care provided to them by their government.[212][213]
10 Reform
17
With the recent healthcare changes, many legal immigrants with various immigration statuses now are able
qualify for aordable health insurance.[232] Options vary
according to the immigrants age and how long they have
been permanent residents.[233]
12
14 Notes
Visitors to the U.S. cannot purchase health insurance
that is available for U.S. citizens and permanent residents. Most domestic insurance policies purchased overseas cease to be eective inside the U.S., when individuals cross their home country borders during international
travel. Currently, it is not mandatory for short-term visitors to U.S. to provide proof of travel medical insurance
coverage to obtain a legal visa to enter the U.S. However,
considering cost of healthcare for the uninsured in the
U.S., many foreigners without residence in the U.S., and
visiting the U.S. can benet by buying a visitors health insurance protection plan that covers emergency expenses
such as medical evacuation and treatment for sickness or
injuries while in the U.S.[234]
13
See also
15 References
[1] Rosenthal, Elisabeth (December 21, 2013). News Analysis - Health Cares Road to Ruin. New York Times. Retrieved December 22, 2013.
[2]
[3] Country Comparison: Life Expectancy at Birth. The
World Factbook. CIA. Retrieved October 25, 2011.
[4] The State of US Health, 19902010: Burden of Diseases, Injuries, and Risk Factors (PDF). Journal of the
American Medical Association 310 (6): 591608. July 10,
2013. doi:10.1001/jama.2013.13805. PMID 23842577.
Retrieved July 11, 2013.
[5] U.S. Health in International Perspective: Shorter Lives,
Poorer Health (2013) National Institutes of Health Committee on Population, Board on Population Health and
Public Health Practice
[6] Martin, Nicole (August 21, 2007). UK cancer survival
rate lowest in Europe. The Telegraph (London). Retrieved August 19, 2013.
[7] Verdecchia A, Francisci S, Brenner H, Gatta G, Micheli
A, Mangone L, Kunkler I (September 2007). Recent
cancer survival in Europe: a 200002 period analysis
of EUROCARE-4 data.. The lancet oncology 8 (9):
78496. doi:10.1016/s1470-2045(07)70246-2. PMID
17714993. Retrieved August 19, 2013.
[8] MD, Scott W. Atlas, (2011). In excellent health : setting
the record straight on Americas health care and charting a
path for future reform. Stanford, California: Hoover Institution Press, Stanford University. pp. 199205. ISBN
0817914447.
[9] Atlas 2011, pp. 205207
[10] Wolf-Maier,
K.
(November
24,
2003).
Hypertension Treatment and Control in Five
European Countries, Canada, and the United
1017.
States (PDF). Hypertension 43 (1):
doi:10.1161/01.HYP.0000103630.72812.10. Retrieved
August 19, 2013.
18
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[28] Johnson, Avery (September 17, 2010). Recession swells
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uninsured Americans rises to 50.7 million. USA
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Further reading
26
18
18
18.1
Health care in the United States Source: https://en.wikipedia.org/wiki/Health_care_in_the_United_States?oldid=683730695 Contributors: SimonP, Edward, Kwertii, Fred Bauder, Ronz, Angela, MichaK, Selket, Saltine, Pakaran, Dale Arnett, Jakohn, E0N, Seano1, Anthony,
Alan Liefting, Wwoods, Lucky 6.9, MSTCrow, Stevietheman, Erich gasboy, Antandrus, Beland, Bumm13, Neutrality, Discospinster, Rich
Farmbrough, FT2, LindsayH, Indrian, Bender235, ESkog, Petersam, Coolcaesar, Femto, Bobo192, Giraedata, Crust, Alison9, Alansohn,
Guy Harris, Tek022, Riana, Wikidea, SlimVirgin, Kurieeto, Velella, Omphaloscope, Versageek, SteinbDJ, Btornado, FrancisTyers, Richard
Arthur Norton (1958- ), Ixistant, Woohookitty, Mindmatrix, Jasoncward, Dhakk, Bkwillwm, Wikiklrsc, Falkone, Qwertyus, Imersion,
Grammarbot, BorgHunter, Drbogdan, Rjwilmsi, Jake Wartenberg, Captain Disdain, Ligulem, Yug, The wub, Sango123, Wikiliki, Ground
Zero, Rasbelin, AED, Gjudd, Winhunter, Crazycomputers, SouthernNights, Psoreilly, Meyer, Imnotminkus, Frappyjohn, VolatileChemical, Digitalme, Shaggyjacobs, Wavelength, Pip2andahalf, RussBot, Hauskalainen, Murphyj87, Briaboru, Ansell, Stephenb, Brec, Johnheywood, CambridgeBayWeather, Rsrikanth05, Morphh, ENeville, DB, Tne80, Twin Bird, Rjensen, Vmjaishankar, Gcalleja, FoolsWar,
Wknight94, Pesco, American2, Alister Namarra, Jules.LT, Chase me ladies, I'm the Cavalry, Pb30, Roberts83, Zen444, CWenger, Badgettrg, Rathfelder, Katieh5584, Kungfuadam, NeilN, Sardanaphalus, Jhelleranta, SmackBot, Davepape, KnowledgeOfSelf, Timeshifter,
Simulato, Timotheus Canens, Srnec, Gilliam, Hmains, Chris the speller, Kurykh, Thumperward, Silly rabbit, BrendelSignature, Deli nk,
Fightcancer, MaxSem, Can't sleep, clown will eat me, KaiserbBot, Waskyo, Rrburke, Charoon~enwiki, Cybercobra, Nakon, Speedplane,
Oanabay04, BullRangifer, TCorp, Kukini, Kristenq, Acidburn24m, Scientizzle, Tomhubbard, Mgunn, Disposition, Emach, Shirleypigott, Yogesh Khandke, Beetstra, Dbo789, Rubikfreak, Sjsharksrs, Levineps, BranStark, Rcroden, Iridescent, K, Sameboat, Joseph Solis in
Australia, Walton One, Mrdthree, CmdrObot, Sjmcfarland, Mineral, Makeemlighter, Leevanjackson, TVC 15, KnightLago, Kbiel, THF,
Christinam, Argon233, Gregbard, Cydebot, Gogo Dodo, Anthonyhcole, Dancter, Homeworld1031tx, Tawkerbot4, Thematt523, Abtract,
Marielleh, Click23, Epbr123, Mojo Hand, Trevyn, Bobblehead, SusanLesch, Futurebird, Sad mouse, RobotG, Majorly, Obiwankenobi,
Seaphoto, Prolog, David Shankbone, SFairchild, Barek, MER-C, The Transhumanist, Mcorazao, Ph.eyes, Jpcroom, ReignMan, Globalhealth, SiobhanHansa, VoABot II, MastCell, JNW, Telanis, Romper, Harelx, Recurring dreams, CJKreklow, Nemogbr, Kope, DerHexer,
JaGa, Sue Gardner, Mschier, DGG, Flowanda, MartinBot, Rundar, CliC, Knightskye, AlexiusHoratius, Onixz100, Gridge, Mbhiii,
Francis Tyers, J.delanoy, Captain panda, Pharaoh of the Wizards, Tlim7882, AstroHurricane001, Nbauman, Boghog, Xris0, WarthogDemon, PedEye1, Jdhalv, Mikael Hggstrm, Ahuskay, Jorfer, Flatterworld, All Male Action, Student7, Bob Hyneman, Joshua Issac, Je330,
Scott Illini, Andy Marchbanks, Jameshrh, Burlywood, Christopher Mann McKay, Skyadd, JoeCarson, VolkovBot, Fbifriday, Nathanaver,
DSRH, Soliloquial, Philip Trueman, FitzColinGerald, Technopat, C.J. Grin, DocteurCosmos, Andrewaskew, Hennap, Cmcnicoll, Falcon8765, Farcaster, Sfmammamia, Pckl300, Daaman23, Skatewife, Azazyel, Lowellk, Dustinepperson, Grundle2600, Toddst1, Flyer22,
Pattigustafson, Myszenka, ERBrownUCLA, Jdaloner, Jontts~enwiki, Kumioko (renamed), AuburnPiIot, Reneeholle, Ward20, Hordaland,
Counterfact, Faithlessthewonderboy, ClueBot, WriterListener, Cambrasa, Personalnancewriter, ImperfectlyInformed, Mild Bill Hiccup,
Denna Haldane, Niceguyedc, Ottawahitech, Historian 1000, TheSmuel, Wikiberda, Arunsingh16, Wsmith4474, Excirial, Accius, Monobi,
Rechtco, 12 Noon, Leonard^Bloom, Happygamer101, Iamthegod2, Rdbiddle, Bracton, Razorame, FridolinXXVI, Redthoreau, Jatiyadown, Jgnbr, Reneewhyler79, Navy II, Mjun88, Versus22, Apatens, DumZiBoT, Nskrill, Doopdoop, Alex1996Ne, XLinkBot, Mjharrison,
Mousequakes, Jytdog, EastTN, Bradv, Dthomsen8, WikHead, JMadeleine, Rory1972, WikiDao, Zodon, Rslate, Thatguyint, Danielroberts, HexaChord, Brilliantine, Luwilt, The Squicks, Addbot, Alexuscamus, Stoop90, Eeisenberg, Jafeluv, DOI bot, Jojhutton, Fyrael,
Atethnekos, Chcf, Lifeguard Emeritus, Scientus, Rdeiriar, Conningcris, Cst17, Download, Thrill going up, AndersBot, Debresser, NittyG,
Favonian, SpBot, Haroldham, Labriut, Zorrobot, Jarble, JEN9841, TellRamad444, Yobot, Tohd8BohaithuGh1, Sveryk, Cm001, Legobot
II, Ekcnho, Randersonn, Pganas, Laurenlt, FeydHuxtable, Backslash Forwardslash, DiverDave, AnomieBOT, Sb101, Innab, Goodrule, Lwiley3, Flewis, Bluerasberry, Citation bot, Eumolpo, Xqbot, TheAMmollusc, Shawnlower, A455bcd9, Jerey Mall, Prowler08, PrevMedFellow, Resetti 4 Prez, Srich32977, Callacatacat, Samminers, Vivek Thud, Frankie0607, Likesausages, Kylelovesyou, Sift&Winnow, Thanmark412, Daleyj, JulianDelphiki, Doulos Christos, Cosmic Cowboy, Moxy, Open Road Rider, LincolnSt, Simplemeasures, Dougofborg,
RightCowLeftCoast, Sko1221, FrescoBot, Bgriggs, User F203, Mark Renier, Tomeczak, Adam9389, Michael93555, Astorpilot, Citation
bot 1, Yamanimal, Redjw, Jonesey95, Sjmyers07, Lydia golis, Brian Everlasting, Forp, Kstart, Reconsider the static, Mycajah, Statsagogo,
Limape, Masterofthewatch, WikiReadr, Needthetruth, Catinator, HCUP US, Vrenator, Danieldis47, Mikedavidwhite, Anwalkr, 564dude,
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Wikipelli, Sheeana, Kaimakides, Mz7, Kkm010, Knabber~enwiki, Greath68, Smartpants321, Jmarshall189, Kiwi128, Nico404, H3llBot,
Shanekruger, Ajdamico, Tolly4bolly, AutoGeek, Josepheidelberg, Stevewetson, Jesanj, EndlessCoee54, Divagador, GermanJoe, LZ6387,
87v7t76fc4iguwevf7657436253yd4fug754ws67dtfugiy67t8576, ClueBot NG, Iiii I I I, Somedierentstu, Intoronto1125, TerryNF, 65 fdt
6a, Patapsco913, J.doremus, Widr, Helpful Pixie Bot, Big Dulles, Lhastey, BG19bot, IluvatarBot, , Wasatch Guy, Narwell, Laurent.pilon, Klilidiplomus, Flamegod7, Vssandhya, Pratyya Ghosh, Cyberbot II, Khazar2, TylerDurden8823, Ahelpinghandvp1,
AutomaticStrikeout, Dexbot, Diskonnection, VictorD7, Psgill1, Cupco, Kp powell, Epicgenius, PWNGWN, Traxana, Neo Poz, Catrunleen, Riniti, EllenCT, Mattnjaime8, Sladkjksdj, Alice Person, Derpinmyderp, Oscaraaronchavez, Rhizomeman, Ethically Yours, Monkbot,
Kukt, Sciophobiaranger, Chirnatr, TheMacDaniel, Crystallizedcarbon, Wikispring, Leonastevens, Genesis walker, Bristolhcs, Sammycarls,
Bloodygun32, Hilmarel, Carhutt and Anonymous: 648
18.2
Images
18.3
Content license
27
Economic Advisers (2009-06). The Economic Case for Health Care Reform (PDF) 10. Executive Oce of the President of the United
States. Retrieved on 2009-08-25. Original artist: Council of Economic Advisers to the President of the United States
File:Life_expectancy_vs_healthcare_spending.jpg Source: https://upload.wikimedia.org/wikipedia/commons/d/d6/Life_expectancy_
vs_healthcare_spending.jpg License: Public domain Contributors: Americas inecient health-care system: another look Consider the
Evidence (blog) Original artist: Lane Kenworthy
File:MedCorpsBC.gif Source: https://upload.wikimedia.org/wikipedia/commons/e/e2/MedCorpsBC.gif License: Public domain Contributors: ? Original artist: ?
File:Salk-child-Karsh.jpg Source: https://upload.wikimedia.org/wikipedia/en/e/e4/Salk-child-Karsh.jpg License: ? Contributors:
Wisdom Magazine, Aug. 1956 (Vol 1, No. 8)
Original artist:
Yousuf Karsh, photographer
File:U.S._Healthcare_Costs_Per_Capita.png Source:
https://upload.wikimedia.org/wikipedia/commons/6/60/U.S._Healthcare_
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File:U.S._Healthcare_Costs_as_a_Percentage_of_GDP.png
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18.3
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