This paper examines the strengths and weaknesses of the United States healthcare finance and delivery system through the lens of social determinants of population health. It highlights key advantages — including advancements in telemedicine, value-based care models, and transparency mandates — while identifying significant drawbacks such as high costs, inadequate insurance coverage, and lack of price transparency. Using OECD Health at a Glance 2019 indicators, the paper compares US healthcare expenditures and outcomes against other OECD nations, noting that the US leads in per-capita spending yet shows mixed results in clinical outcomes, performing well in breast cancer survival and stroke mortality but poorly in preventable hospital admissions for chronic conditions.
The US healthcare delivery system operates within a complex finance and delivery structure that produces both notable strengths and significant weaknesses. Understanding these dynamics requires examining the system through the lens of social determinants of population health and comparing US performance against international benchmarks provided by the Organisation for Economic Co-operation and Development (OECD).
The US healthcare delivery system offers quality healthcare to patients, particularly those who can afford premium insurance coverage. The quality of care is driven by advancements in telemedicine, which have made healthcare more accessible at any time via virtual platforms (Mason et al., 2020). Innovations such as home-based care, accountable care organizations, and high-level patient engagement through health information technology give patients and families greater control over the care they receive (Mason et al., 2020).
Policies and laws that mandate comparative effectiveness research and impose Medicare payment restrictions in the event of medication errors also increase the quality of care delivered (Mason et al., 2020). The US healthcare delivery system is additionally advantageous in terms of transparency, which is evident in policies requiring hospitals to make public hospital-specific information that patients can use as a measure of compliance and performance (Mason et al., 2020). A third key advantage is the ongoing shift from fee-for-service to value-based care, which research has shown to be more effective in promoting positive health outcomes and illness prevention (Leao et al., 2023).
On the other hand, the US healthcare finance and delivery system has significant disadvantages. First, the cost of healthcare is high because the system still largely depends on the fee-for-service reimbursement model (Shrank et al., 2021). Underinsured and uninsured individuals are thus forced to pay extremely high out-of-pocket costs, which further worsens health disparities (Mason et al., 2020). Healthcare access remains a challenge, as a large proportion of the population lacks adequate insurance coverage (Mason et al., 2020).
At the same time, weaknesses in the Affordable Care Act (ACA) have made it relatively easy for Americans to lose coverage. It is estimated that four million adults lost coverage since 2014, and that the proportion of uninsured adults increased from 20.9 percent in 2016 to 25.7 percent in 2018 (Mason et al., 2020). Finally, the system lacks adequate price transparency, which makes it difficult for patients to compare facilities and find budget-friendly options (Pollack, 2022). This lack of transparency enables healthcare facilities to charge different prices for the same service, to the detriment of patients — particularly those from low-income households (Pollack, 2022).
The OECD defines health expenditure as the total spending on health goods and services in a country in a given year, including spending from out-of-pocket, social insurance, and government-based programs (OECD, 2019). Data from 2018 shows that the US has the highest health expenditure per capita among all OECD countries (OECD, 2019). The US reports a per-capita health expenditure of over $10,000, which is more than twice the OECD average of $3,994 (OECD, 2019). Based on the presented data, the US is the only country above $7,500 in per-capita health expenditure among OECD members (OECD, 2019).
Similarly, the US reports the highest health expenditure as a share of Gross Domestic Product (GDP) at 16.9 percent, compared to second-placed Switzerland at 12 percent and the OECD average of 8.8 percent (OECD, 2019). This high health expenditure reflects the elevated cost of healthcare in the US relative to other OECD countries, most likely driven by the continued dependence on the fee-for-service reimbursement model.
"Mixed US outcomes versus OECD averages across conditions"
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