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Top1. Introduction
The US healthcare system has both strengths and weaknesses. It enjoys a large-scale, well-trained, and high-quality workforce of clinicians, nurses, and specialists, robust medical research programs, and the world’s best clinical outcomes in select medical services. Yet, it suffers from high expenditure, low performance, and disparity in health status, access to care, and outcomes of care (Barnes, Unruh, Rosenau, & Rice, 2018).
1.1. High Cost of the US Healthcare System
According to a recent report published by The Organization for Economic Co-operation and Development (2018), in 2017 the US spending on healthcare was the largest, measured by both the spending per capita and the percentage of the gross domestic product (GDP) among its 37 member nations. Figure 1 shows that the US spent over $10,000 per capita on healthcare that year, or about 17% of GDP.
Figure 1. 2017 health spending per capita as share of GDP (Organization for Economic Co-operation and Development, 2018, p. 2)
Even more alarming is the rapid growth in US healthcare spending. According to the Centers for Medicare and Medicaid Services (CMS), healthcare spending is projected to grow at an average rate of 5.8 percent from 2012-2022, 1.0 percentage point faster than the expected average annual growth in the GDP. By 2022, US healthcare spending is projected to be nearly 20% of GDP (Centers for Medicare and Medicaid Services, 2012).
This extremely high spending is sharply contrasted with the low performance in the US healthcare system. In 2000, the World Health Organization (WHO) published a report that measured and ranked the health system performance of 191 countries. According to this report, the US healthcare system was unimpressively ranked at 37, below most industrialized countries including France, the UK, and Canada, and even below some less developed countries such as Colombia and Chile (Tandon, Murray, Lauer, & Evans, 2000). Almost two decades later, there has not been much improvement in the performance of the US healthcare system. According to a 2017 report from the Commonwealth Fund, the US is ranked last out of 11 high-income industrialized countries based on measures including care process, access to care, administrative efficiency, equity, and health outcomes (Schneider, Sarnak, Squires, Shah, & Doty, 2017). Figure 2 shows that the US healthcare system performs at the bottom on four of the five measures.
Figure 2. 2017 healthcare systems performance ranking (Schneider et al., 2017)