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A Profile of the Health Sector in the United States

PharmacoEconomics volume 20, pages 31–45 (2002)Cite this article

Abstract

The health sector in the US is almost equally divided between public and private sector programmes in terms of spending, and both sectors are facing significant pressures for change. This paper provides an overview of the sectors today and the populations they serve, explores the challenges they are experiencing, and identifies options for changes that move toward a more consumer focused system that responds to the discipline of the marketplace rather than to bureaucratic rules and regulations. The changes we explore can not only help establish foundations for the US to embrace and facilitate the great progress in medicine that will certainly come over the next decade and beyond, but may also provide ideas for other nations facing similar challenges with their own healthcare systems.

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Notes

  1. Some people have coverage through more than one healthcare programme, so totals may not add up.

  2. The rules include Medicare legislation and regulation, fraud and abuse regulation, the Balanced Budget Act of 1997, the Centers for Medicare & Medicaid Services (CMS) manuals, CMS Federal Register pages, carrier manuals, coding manuals, carrier newsletters, intermediary communications, intermediary Medicare bulletins, CMS administrator decisions, and nearly three dozen other document sets.

  3. By providing a refundable tax credit worth, for example, $US1000 for individuals and $US2000 for families, Congress could dramatically increase the options for the uninsured to obtain coverage. Professor Mark Pauly of the Wharton School estimates that as many as 85% of the uninsured would buy health insurance that has a $US1000 deductible (or ‘excess’), a 20% copayment requirement and a $US2000 limit on out-of-pocket spending.

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Acknowledgements

Tara Persico of the Galen Institute assisted in research for this manuscript.

The author wishes to thank the reviewers and editors for their comments and assistance in the preparation of this manuscript. No grants or other funds were provided to influence its content, and the author has no conflicts of interest with regard to its conclusions.

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  1. Galen Institute, Inc., PO Box 19080, Alexandria, Virginia, 22320, USA

    Grace-Marie Turner

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  1. Grace-Marie Turner
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Correspondence to Grace-Marie Turner.

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Turner, GM. A Profile of the Health Sector in the United States. Pharmacoeconomics 20, 31–45 (2002). https://doi.org/10.2165/00019053-200220003-00003

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Keywords

  • Health Insurance
  • Health Coverage
  • Private Health Insurance
  • Medicare Beneficiary
  • Pharmaceutical Innovation