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The healthcare system in the United States can be traced back to the [[Colonial history of the United States|Colonial Era]].<ref>Carl Bridenbaugh, ''Cities in the Wilderness: The First Century of Urban Life in America 1625-1742'' (1938) p 401</ref> Community-oriented care was typical, with families and neighbors providing assistance to the sick.<ref name="Robinson, Martha 2005">Robinson, Martha. 2005. New Worlds, New Medicines: Indian Remedies and English Medicine in Early America. Early American Studies (Spring): 94-110.</ref><ref>Jacob Ernest Cooke, ed. ''Encyclopedia of the North American colonies'' (3 vol 1992) 1:214</ref> During the 19th century, the practice of medicine began to professionalize, following the “Anglo-American model” where these new medical professionals were empowered by the state to govern their own affairs, leading to various collaborations to acquire status and win legislation granting them the power to self-regulate.<ref name="Adams 72">{{Cite journal |last=Adams |first=Tracey L. |date=2020-10-20 |title=Health professional regulation in historical context: Canada, the USA and the UK (19th century to present) |journal=Human Resources for Health |language=en |volume=18 |issue=1 |pages=72 |doi=10.1186/s12960-020-00501-y |doi-access=free |issn=1478-4491 |pmc=7572238 |pmid=33076923}}</ref> The establishment of [[medical schools]] and professional organizations led to standardized training and certification processes for doctors.<ref>Richard Morris ''Encyclopedia of American History'' (1976) p 806.</ref> Despite this progress, healthcare services remained disparate, particularly between urban and rural areas. The concept of hospitals as institutions for the sick began to take root, leading to the foundation of many public and private hospitals.<ref>{{Cite book |last1=Breslaw |first1=Elaine G. |title=Lotions, Potions, Pills, and Magic: Health Care in Early America |date=March 2014 |publisher=NYU Press |isbn=978-1479807048}}</ref>
[[File:Bellevue_Psychiatric_Hospital_old_building.jpg|thumb|right|250px|[[Bellevue Hospital]] Bellevue Hospital is one of the oldest [[public hospital]]s in the United States,. It is located in [[Manhattan]].]]
The latter part of the 20th century saw continued evolution in healthcare policy, technology, and delivery. Following the [[Stabilization Act of 1942]], employers, unable to provide higher salaries to attract or retain employees, began to offer [[insurance]] plans, including [[Health insurance|healthcare packages]], as a [[Employee benefits|benefit in kind]], thereby beginning the practice of employer-sponsored health insurance, a practice that is cemented into the work culture of today.<ref>{{cite journal |last=Thomasson |first=Melissa A. |name-list-style=vanc |date=July 2002 |title=From Sickness to Health: The Twentieth-Century Development of U.S. Health Insurance |journal=Explorations in Economic History |language=en |volume=39 |issue=3 |pages=233–253 |doi=10.1006/exeh.2002.0788 |s2cid=30393803}}</ref> The [[Health Maintenance Organization Act of 1973]] encouraged the development of managed care, while advances in medical technology revolutionized treatment. In the 21st century, the [[Affordable Care Act]] (ACA) was passed in 2010, extending healthcare coverage to millions of uninsured Americans and implementing reforms aimed at improving quality and reducing costs.<ref>{{cite journal |last1=Gruber |first1=Jonathan |date=2011 |title=The Impacts of the Affordable Care Act: How Reasonable Are the Projections? |url=https://economics.mit.edu/files/11416 |url-status=dead |journal=National Tax Journal |volume=64 |issue=3 |pages=893–908 |doi=10.17310/ntj.2011.3.06 |s2cid=232213290 |archive-url=https://web.archive.org/web/20160620124250/http://economics.mit.edu/files/11416 |archive-date=2016-06-20 |access-date=July 23, 2017 |hdl=1721.1/72971}}</ref>
 
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=== Health insurance and accessibility ===
{{Main|Health insurance coverage in the United States|Health insurance in the United States}}
[[File:U.S. Uninsured and Uninsured Rate (1987 to 2008).JPG|thumb|upright=1.6|The numbers of uninsured Americans and the uninsured rate from 1987 to 2008]]Unlike most [[Developed country|developed nations]], the US health system does not provide healthcare to the country's entire population.<ref name="IOM 2004">{{cite book |url=https://archive.org/details/insuringamericas00inst/page/25|title=Insuring America's health: principles and recommendations|author=Institute of Medicine. Committee on the Consequences of Uninsurance|date=January 13, 2004 |publisher=National Academies Press|isbn=978-0-309-52826-9|location=Washington, DC|page=[https://archive.org/details/insuringamericas00inst/page/25 25]}}</ref> In 1977, the United States was said to be the only industrialized country not to have some form of national health insurance or direct healthcare provision to citizens through a nationalized healthcare system.<ref>[https://wwwbooks.google.co.ukcom/books/edition/Health_Care_Problems_in_Rural_and_Small/yA0QzViGaeAC?hlid=en&gbpv=1yA0QzViGaeAC&dq=Health+Security+Act,+S.+3,+is+the+legislation+best+able+to+provide+adequate+health+care+to+all+Americans&pg=PA126&printsec=frontcover Health Care Problems in Rural and Small Communities (Macon, Ga., and Atlanta, Ga.) Joint Hearings Before the Subcommittee on Health of the Committee on Finance and Committee on Governmental Affairs, United States Senate, Ninety-fifth Congress, First Session, August 16 and 18, 1977 By United States. Congress, Senate, Committee on Finance, Subcommittee on Health, 1978, P.126]</ref> A 1978 study argued that “Today every government in the world-including Red China with its squadrons of semi-trained “barefoot doctors”-realizes it has a responsibility to keep its citizens in good physical and mental health. Unlike the U.S., nations like Scandinavia, the U.K., Ireland, Japan and others have opted for a universal health care system in which the state pays everyone's medical bills.”<ref>The Book of Numbers, compiled by the Editors of Heron House, 1978, P.231</ref> Instead, most citizens are covered by a combination of private insurance and various federal and state programs.<ref>Access to health care in America. Institute of Medicine, Committee on Monitoring Access to Personal Health Care Services. Millman M, editor. Washington: National Academies Press; 1993.</ref> {{As of|2017}}, health insurance was most commonly acquired through a [[Group insurance|group plan]] tied to an employer, covering 150&nbsp;million people.<ref name=":11">{{Cite journal |url=https://www.commonwealthfund.org/blog/2017/decline-employer-sponsored-health-insurance|title=The Decline of Employer-Sponsored Health Insurance|website=commonwealthfund.org|year=2017|doi=10.26099/dnqz-4g48|language=en |access-date=2018-11-25|last1=Blumenthal|first1=David}}</ref> Other major sources include Medicaid, covering 70&nbsp;million, Medicare, 50&nbsp;million, and [[health insurance marketplace]]s created by the [[Affordable Care Act|ACA]] covering around 17&nbsp;million.<ref name=":11" /> In 2017, a study found that 73% of plans on ACA marketplaces had narrow networks, limiting access and choice in providers.<ref name=":11" />
 
Healthcare coverage is provided through a combination of private health insurance and public health coverage (e.g., Medicare, Medicaid). In 2013, 64% of health spending was paid for by the government,<ref>{{cite journal | vauthors = Himmelstein DU, Woolhandler S | title = The Current and Projected Taxpayer Shares of US Health Costs | journal = American Journal of Public Health | volume = 106 | issue = 3 | pages = 449–52 | date = March 2016 | pmid = 26794173 | pmc = 4880216 | doi = 10.2105/AJPH.2015.302997 | quote = Government's share of overall health spending was 64% of national health expenditures in 2013 }}</ref><ref>{{cite magazine|last=Leonard|first=Kimberly| name-list-style = vanc |date=January 22, 2016|title=Could Universal Health Care Save U.S. Taxpayers Money?|url=https://www.usnews.com/news/blogs/data-mine/2016/01/22/could-universal-health-care-save-us-taxpayers-money|magazine=U.S. News & World Report|access-date=July 12, 2016}}</ref> and funded via programs such as [[Medicare (United States)|Medicare]], [[Medicaid]], the [[Children's Health Insurance Program]], [[Tricare]], and the [[Veterans Health Administration]]. People aged under 65 acquire insurance via their or a family member's employer, by purchasing health insurance on their own, getting government and/or other assistance based on income or another condition, or are uninsured. [[Health insurance in the United States|Health insurance]] for [[public sector]] employees is primarily provided by the government in its role as employer.<ref>{{Cite news|url=http://www.fedweek.com/retirement-financial-planning/fehb-relates-government-health-insurance/|title=How FEHB Relates to Other Government Health Insurance|date=May 25, 2017|work=FEDweek|access-date=May 26, 2017|language=en-US}}</ref> [[Managed care]], where payers use various techniques intended to improve quality and limit cost, has become ubiquitous.
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The [[United States Census Bureau|US Census Bureau]] reported that 28.5&nbsp;million people (8.8%) did not have health insurance in 2017,<ref>{{Cite web|url=https://www.census.gov/library/publications/2018/demo/p60-264.html|title=Health Insurance Coverage in the United States: 2017|website=census.gov|language=en-US|access-date=2018-11-25}}</ref> down from 49.9&nbsp;million (16.3%) in 2010.<ref name="DeNavas-Walt 2011">{{cite book|url=https://www.census.gov/prod/2011pubs/p60-239.pdf|title=Income, poverty, and health insurance coverage in the United States: 2010|last1=DeNavas-Walt|first1=Carmen|last2=Proctor|first2=Bernadette D.|last3=Smith|first3=Jessica C. | name-list-style = vanc |date=September 13, 2011|publisher=U.S. Government Printing Office|series=U.S. Census Bureau: Current Population Reports, P60-239|location=Washington, DC}}</ref><ref name="uninsured 2009">{{cite news|url=https://www.wsj.com/articles/SB10001424052748704394704575496093363948142|title=Recession swells number of uninsured to 50.7 million|author=Johnson, Avery|date=September 17, 2010|newspaper=The Wall Street Journal|access-date=November 21, 2010|page=A4}}
 
* {{cite news|url=https://www.usatoday.com/news/nation/2010-09-17-uninsured17_ST_N.htm|title=Number of uninsured Americans rises to 50.7 million| last = Wolf | first = Richard | name-list-style = vanc |date=September 17, 2010|newspaper=USA Today|access-date=November 21, 2010|page=8A}}
* {{cite web|url=https://www.census.gov/prod/2010pubs/p60-238.pdf|title=Income, poverty, and health insurance coverage in the United States: 2009| last1 = DeNavas-Walt | first1 = Carmen | last2 = Proctor | first2 = Bernadette D. | name-list-style = vanc |date=September 16, 2010|publisher=U.S. Census Bureau|location=Washington, D.C.|access-date=November 21, 2010|author3=Smith, Jessica C.}}
* {{cite web|url=http://meps.ahrq.gov/mepsweb/data_files/publications/st291/stat291.pdf|title=The uninsured in America, first half of 2009: estimates for the United States civilian noninstitutionalized population under age 65. Medical Expenditure Panel Survey, Statistical Brief #291| last1 = Roberts | first1 = Michelle | last2 =Rhoades | first2 = Jeffrey A. | name-list-style = vanc |date=August 19, 2010|publisher=Agency for Healthcare Research and Quality (AHRQ)|location=Rockville, Md.|access-date=November 21, 2010}}
* {{cite web|url=https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201009.pdf|title=Health insurance coverage: early release of estimates from the National Health Interview Survey, January–March 2010| last1 = Cohen | first1 = Robin A. | last2 = Martinez | first2 = Michael A. | name-list-style = vanc |date=September 22, 2010|publisher=National Center for Health Statistics (NCHS)|location=Hyattsville, Md.|access-date=November 21, 2010}}
* {{cite web|url=http://www.shadac.org/files/RWJF_CompareSurveysIB_Aug2008.pdf|title=Comparing federal government surveys that count uninsured people in America|date=August 26, 2008|publisher=State Health Access Data Assistance Center, School of Public Health, University of Minnesota|location=Minneapolis, Minn.|access-date=November 21, 2010|archive-date=March 29, 2012|archive-url=https://web.archive.org/web/20120329181112/http://www.shadac.org/files/RWJF_CompareSurveysIB_Aug2008.pdf|url-status=dead}}</ref> Between 2004 and 2013, a trend of high rates of underinsurance and [[wage stagnation]] contributed to a healthcare consumption decline for low-income Americans.<ref>{{cite journal | vauthors = Dickman SL, Woolhandler S, Bor J, McCormick D, Bor DH, Himmelstein DU | title = Health Spending For Low-, Middle-, And High-Income Americans, 1963-2012 | journal = Health Affairs | volume = 35 | issue = 7 | pages = 1189–96 | date = July 2016 | pmid = 27385233 | doi = 10.1377/hlthaff.2015.1024 | url = https://dash.harvard.edu/bitstream/handle/1/27007724/DICKMAN-DOCTOROFMEDICINETHESIS-2016.pdf?sequence=3&isAllowed=y | doi-access = free | url-access = | url-status = | archive-url = | archive-date = }}</ref> This trend was reversed after the implementation of the major provisions of the ACA in 2014.<ref name=":0">{{cite journal | vauthors = Dickman SL, Himmelstein DU, Woolhandler S | title = Inequality and the health-care system in the USA | journal = Lancet | volume = 389 | issue = 10077 | pages = 1431–1441 | date = April 2017 | pmid = 28402825 | doi = 10.1016/s0140-6736(17)30398-7 | s2cid = 13654086 }}</ref>
 
[[File:Medicaid expansion map of US. Affordable Care Act.svg|thumb|upright=1.35|[[Medicaid coverage gap#Medicaid expansion|ACA Medicaid expansion]] by state.<ref name="KFF-Medicaid">{{cite web |title=Status of State Medicaid Expansion Decisions: Interactive Map |date=March 20, 2024 |url=https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map |publisher=[[Kaiser Family Foundation|KFF]]. Map is updated as changes occur. Click on states for details.}}</ref>
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{{legend|#89CC7F|Adopted}}
{{legend|#FECDAC|Implemented}}]]
{{As of|2017}}, the possibility that the ACA may be repealed or replaced has intensified interest in the questions of whether and how health insurance coverage affects health and mortality.<ref name=":1">{{cite journal | vauthors = Sommers BD, Gawande AA, Baicker K | title = Health Insurance Coverage and Health - What the Recent Evidence Tells Us | language = EN | journal = The New England Journal of Medicine | volume = 377 | issue = 6 | pages = 586–593 | date = August 2017 | pmid = 28636831 | doi = 10.1056/nejmsb1706645 | s2cid = 2653858 }}</ref> Several studies have indicated that there is an association with expansion of the ACA and factors associated with better health outcomes such as having a regular source of care and the ability to afford care.<ref name=":1" /> A 2016 study concluded that an approximately 60% increased ability to afford care can be attributed to Medicaid expansion provisions enacted by the Patient Protection and Affordable Care Act.<ref>{{cite journal | vauthors = Frean M, Gruber J, Sommers BD | title = Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act | journal = Journal of Health Economics | volume = 53 | pages = 72–86 | date = May 2017 | pmid = 28319791 | doi = 10.1016/j.jhealeco.2017.02.004 | hdl = 1721.1/129483 | s2cid = 3759121 | url = http://www.nber.org/papers/w22213.pdf | hdl-access = free }}</ref> Additionally, an analysis of changes in mortality post Medicaid expansion suggests that Medicaid saves lives at a relatively more cost effective rate of a societal cost of $327,000 to $867,000 (equivalent to ${{Formatprice|{{inflation|US|327000|2016}}}} to ${{Formatprice|{{inflation|US|867000|2016}}}} in {{Inflation/year|index=US}}{{Inflation/fn|index=US}}) per life saved compared to other public policies which cost an average of $7.6&nbsp;million (equivalent to ${{Formatprice|{{inflation|US|7600000|2016}}}} in {{Inflation/year|index=US}}{{Inflation/fn|index=US}}) per life.<ref>{{Cite journal|last=Sommers |first=Benjamin D.|name-list-style=vanc|date=May 11, 2017 |title=State Medicaid Expansions and Mortality, Revisited: A Cost-Benefit Analysis|journal=American Journal of Health Economics|volume=3|issue=3|pages=392–421|doi=10.1162/ajhe_a_00080|s2cid=53488456|issn=2332-3493 |url=https://dash.harvard.edu/bitstream/1/27305958/1/Mcaid%20Mortality%20Revisited%20DASH%20Version.pdf|url-access=|url-status=|archive-url=|archive-date=}}</ref>
 
A 2009 study in five states found that [[medical debt]] contributed to 46.2% of all [[Bankruptcy in the United States|personal bankruptcies]], and 62.1% of bankruptcy filers claimed high medical expenses in 2007.<ref>{{cite news|url=http://www.cbsnews.com/stories/2009/06/05/earlyshow/health/main5064981.shtml |archive-url=https://web.archive.org/web/20090608074423/http://www.cbsnews.com/stories/2009/06/05/earlyshow/health/main5064981.shtml |url-status=dead |archive-date=June 8, 2009 |title=Medical Debt Huge Bankruptcy Culprit – Study: It's Behind Six-In-Ten Personal Filings|date=June 5, 2009|access-date=June 22, 2009 |publisher=CBS}}</ref><!--refuted by Todd Zywicki's paper on the subject. See http://mason.gmu.edu/~tzywick2/Bankruptcy%20Crisis%20Final.pdf and http://judiciary.house.gov/hearings/July2007/Zywicki070717.pdf--> Since then, health costs and the numbers of uninsured and underinsured have increased.<ref>{{cite news|url=https://money.cnn.com/2009/03/05/news/economy/healthcare_underinsured/|title=Underinsured Americans: Cost to you|last=Kavilanz |first=Parija B.|name-list-style=vanc |date=March 5, 2009|work=CNN}}</ref> A 2013 study found that about 25% of all senior citizens declare bankruptcy due to medical expenses.<ref name="kelley2013">{{cite journal | vauthors = Kelley AS, McGarry K, Fahle S, Marshall SM, Du Q, Skinner JS | title = Out-of-pocket spending in the last five years of life | journal = Journal of General Internal Medicine | volume = 28 | issue = 2 | pages = 304–9 | date = February 2013 | pmid = 22948931 | pmc = 3614143 | doi = 10.1007/s11606-012-2199-x }}</ref>
 
In practice, the uninsured are often treated, but the cost is covered through taxes and other fees which shift the cost.<ref>{{Cite web|last=Groman|first=Rachel|name-list-style=vanc|date=2004|title=The Cost of Lack of Health Insurance|website=American College of Physicians|access-date=22 October 2017 |url=https://www.acponline.org/acp_policy/policies/cost_of_lack_of_health_insurance_1999.pdf|archive-url=https://web.archive.org/web/20160707030157/https://www.acponline.org/acp_policy/policies/cost_of_lack_of_health_insurance_1999.pdf|archive-date=July 7, 2016|url-status=dead}}</ref> Forgone medical care due to extensive cost sharing may ultimately increase costs due to downstream medical issues; this dynamic may play a part in US's international ranking as having the highest healthcare expenditures despite significant patient cost-sharing.<ref name=":0" />
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{{Image frame
| caption={{legend-line|#318CE7 solid 3px|Life expectancy in the US<ref>{{Cite journal|url=https://ourworldindata.org/life-expectancy|title=Life Expectancy|journal=Our World in Data|date=May 23, 2013|last1=Roser|first1=Max|author1-link=Max Roser |last2=Ortiz-Ospina|first2=Esteban|last3=Ritchie|first3=Hannah|author3-link=Hannah Ritchie }}</ref>}}
| content =
{{Graph:Chart
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====Long-term living facilities====
As of 2014, according to a report published<ref>{{cite journal |pmc = 6376502|year = 2019|last1 = Weech-Maldonado|first1 = R.|last2 = Pradhan|first2 = R.|last3 = Dayama|first3 = N.|last4 = Lord|first4 = J.|last5 = Gupta|first5 = S.|title = Nursing Home Quality and Financial Performance: Is There a Business Case for Quality?|journal = Inquiry: AThe Journal of Medical Care Organization, Provision and Financing|volume = 56|pages = 0046958018825191|doi = 10.1177/0046958018825191|pmid = 30739511}}</ref> the higher the skill of the RN the lower the cost of a financial burden on the facilities. With a growing elderly population, the number of patients in these long term facilities needing more care creates a jump in financial costs. Based on research done in 2010,<ref>{{cite journal|pmc = 2763425|year = 2009|last1 = Stewart|first1 = K. A.|last2 = Grabowski|first2 = D. C.|last3 = Lakdawalla|first3 = D. N.|title = Annual expenditures for nursing home care: Private and public payer price growth, 1977–2004|journal = Medical Care|volume = 47|issue = 3|pages = 295–301|doi = 10.1097/MLR.0b013e3181893f8e|pmid = 19194339}}</ref> annual out of pocket costs jumped 7.5% while the cost for Medicare grew 6.7% annually due to the increases. While Medicare pays for some of the care that the elderly populations receive, 40% of the patients staying in these facilities pay out of pocket.<ref>{{cite journal |pmc = 2763425|year = 2009|last1 = Stewart|first1 = K. A.|last2 = Grabowski|first2 = D. C.|last3 = Lakdawalla|first3 = D. N.|title = Annual expenditures for nursing home care: Private and public payer price growth, 1977–2004|journal = Medical Care|volume = 47|issue = 3|pages = 295–301|doi = 10.1097/MLR.0b013e3181893f8e|pmid = 19194339}}</ref>
 
=== Third-party payment problem and consumer-driven insurance ===
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[[File:CDC TB graphic on minority groups being impacted by TB.jpg|thumb|A [[Centers for Disease Control and Prevention|CDC]] image depicting racial health disparities in the US for [[tuberculosis]]]]
 
[[Health disparities]] are well documented in the United States in ethnic minorities such as [[African Americans]], [[Native Americans in the United States|Native Americans]], and [[Hispanics in the United States|Hispanics]].<ref>Goldberg, J., Hayes, W., and Huntley, J. [http://www.healthpolicyohio.org/publications/healthdisparities.html "Understanding Health Disparities."] {{webarchive|url=https://web.archive.org/web/20080515210412/http://www.healthpolicyohio.org/publications/healthdisparities.html|date=May 15, 2008}} Health Policy Institute of Ohio (November 2004), p. 3.</ref> When compared to [[White American|white people]], these minority groups have ''a'' higher incidence of chronic diseases, higher mortality, poorer health outcomes'','' and poorer rates of diagnosis and treatment.<ref>{{Cite book |last1=Smedley |first1=Brian D. |url=http://worldcat.org/oclc/853283904 |title=Unequal treatment: confronting racial and ethnic disparities in health care |last2=Stith |first2=Adrienne Y. |last3=Nelson |first3=Alan R. |date=2003 |publisher=National Academy Press |isbn=978-0-309-21582-4 |oclc=853283904}}</ref><ref>{{Cite journal |last1=Atdjian |first1=Sylvia |last2=Vega |first2=William A. |date=December 2005 |title=Disparities in Mental Health Treatment in U.S. Racial and Ethnic Minority Groups: Implications for Psychiatrists |url=http://psychiatryonline.org/doi/abs/10.1176/appi.ps.56.12.1600 |journal=Psychiatric Services |language=en |volume=56 |issue=12 |pages=1600–1602 |doi=10.1176/appi.ps.56.12.1600 |issn=1075-2730 |pmid=16339626}}</ref> Among the disease-specific examples of racial and ethnic disparities in the US is the cancer incidence rate among African Americans, which is 25% higher than among white people.<ref name="APHA">American Public Health Association (APHA), Eliminating Health Disparities: Toolkit (2004).</ref> In addition, adult African Americans and Hispanics have approximately twice the risk as white people of developing diabetes and have higher overall obesity rates.<ref>{{cite web |last=Campanile |first=Carl |name-list-style=vanc |date=November 23, 2012 |title=Americans are getting fatter: poll |url=http://www.nypost.com/p/news/national/we_regoing_wide_UBV52r2Rl9hejdZDaGTgNM |access-date=December 1, 2016 |website=Nypost.com |publisher=New York Post}}</ref> Minorities also have higher rates of [[cardiovascular disease]] and [[HIV/AIDS]] than white people.<ref name="APHA" /> In the US, racial demographics are as follows: Asian American (87.1 years), followed by Latino (83.3 years), White (78.9 years), Native American (76.9 years), and African American (75.4 years).<ref>Sarah Burd-Sharps and Kristen Lewis. ''[http://www.measureofamerica.org/congressional-districts-2015/ Geographies of Opportunity: Ranking Well-Being by Congressional District]''. 2015. [[Measure of America]] of the Social Science Research Council.</ref> A 2001 study found distinguished racial differences exist in healthy life expectancy at lower levels of education.<ref>''[http://cat.inist.fr/?aModele=afficheN&cpsidt=1050427 Trends in healthy life expectancy in the united states, 1970–1990: gender, racial, and educational differences] {{Webarchive|url=https://web.archive.org/web/20100317145539/http://cat.inist.fr/?aModele=afficheN&cpsidt=1050427|date=March 17, 2010}}''</ref>
 
Public spending is positively correlated with age; average per capita public spending for seniors was more than five times that for children ($6,921 versus $1,225, equivalent to ${{Formatprice|{{inflation|US|6921|2002}}}} versus ${{Formatprice|{{inflation|US|1225|2002}}}} in {{Inflation/year|index=US}}{{Inflation/fn|index=US}}). Average public spending for non-Hispanic blacks ($2,973, equivalent to ${{Formatprice|{{inflation|US|2973|2002}}}} in {{Inflation/year|index=US}}{{Inflation/fn|index=US}}) was slightly higher than that for white people ($2,675, equivalent to ${{Formatprice|{{inflation|US|2675|2002}}}} in {{Inflation/year|index=US}}{{Inflation/fn|index=US}}) while spending for Hispanics ($1,967, equivalent to ${{Formatprice|{{inflation|US|1967|2002}}}} in {{Inflation/year|index=US}}{{Inflation/fn|index=US}}) was significantly lower than the population average ($2,612, equivalent to ${{Formatprice|{{inflation|US|2612|2002}}}} in {{Inflation/year|index=US}}{{Inflation/fn|index=US}})). Total public spending is also strongly correlated with self-reported health status ($13,770 [equivalent to ${{Formatprice|{{inflation|US|13770|2002}}}} in {{Inflation/year|index=US}}{{Inflation/fn|index=US}}] for those reporting "poor" health versus $1,279 [equivalent to ${{Formatprice|{{inflation|US|1279|2002}}}} in {{Inflation/year|index=US}}{{Inflation/fn|index=US}}] for those reporting "excellent" health).<ref name="content.healthaffairs.org" /> Seniors make up 13% of the population but take one-third of all prescription drugs. The average senior fills 38&nbsp;prescriptions annually.<ref>{{cite news |last=Tronetti |first=Pamela |name-list-style=vanc |date=January 11, 2011 |title=Senior consult:Check drugs supplements to avoid interactions |url=http://www.floridatoday.com/article/20110111/LIFE01/101110310/Dr-Pamela-TronettiI-Check-drugs-supplements-to-avoid-interactions |newspaper=Florida Today |location=Melbourne, Florida |page=1D}}</ref> A new study has also found that older men and women in the South are more likely to be prescribed antibiotics than older Americans elsewhere, even though there is no evidence that the South has higher rates of diseases requiring antibiotics.<ref>{{cite news |last=O'Connor |first=Anahad |name-list-style=vanc |date=September 25, 2012 |title=Well: Antibiotic Prescription? It May Depend on Where You Live |url=http://well.blogs.nytimes.com/2012/09/25/antibiotic-prescription-it-may-depend-on-where-you-live/?emc=rss |work=The New York Times}}</ref>
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[[Medical device]]s are expensive because the process of designing and approving them is extensive and costly, requiring that they be sold at higher than market price. The costs include research, design and development, meeting the U.S. Food and Drug Administration's regulatory guidelines, manufacture, marketing, distribution, and business plan.<ref>{{Cite web |title=Thought Leadership Archives |url=https://sterlingmedicaldevices.com/thought-leadership/ |access-date=2023-04-27 |website=Sterling Medical Devices |language=en}}</ref> Cost, alongside the impact of systematic oppression and inequality of communities of color within healthcare, together make medical equipment inaccessible. Most studies focused on access to medical devices and enhancement of affordable local production have concluded that increasing access to medical devices in an attempt to meet healthcare needs is highly critical.<ref>{{Cite web |title=Towards improving access to medical devices through local production |url=https://www.who.int/publications-detail-redirect/9789241510141 |access-date=2023-04-27 |website=www.who.int |language=en}}</ref>
 
The increase of [[Artificial intelligence in healthcare|artificial intelligence (AI) in health care]] raises issues of equity and bias related to how health applications are developed and used. AI expansion is now of serious global interest towards public and private investment. The [[Harrow London Borough Council|Harrow Council]] launched the IBM Watson Care Manager system to match individuals, considering budget, with a provider and develop individual care plans.<ref>{{Cite web |title=AI in healthcare and research |url=https://www.nuffieldbioethics.org/publications/ai-in-healthcare-and-research |access-date=2024-05-10 |website=The Nuffield Council on Bioethics |language=en-gb}}</ref> Within the US, the [[Food and Drug Administration|FDA]] in 2017 cleared an AI medical imaging platform for clinical use as well as future devices.<ref>{{Citation |last1=Gerke |first1=Sara |title=Chapter 12 - Ethical and legal challenges of artificial intelligence-driven healthcare |date=2020-01-01 |work=Artificial Intelligence in Healthcare |pages=295–336 |editor-last=Bohr |editor-first=Adam |url=https://www.sciencedirect.com/science/article/pii/B9780128184387000125 |access-date=2024-05-10 |publisher=Academic Press |isbn=978-0-12-818438-7 |last2=Minssen |first2=Timo |last3=Cohen |first3=Glenn |editor2-last=Memarzadeh |editor2-first=Kaveh}}</ref> A recent scoping review identified 18 equity issues with 15 strategies to address them to try to ensure that AI applications equitably meet the needs of the populations intended to benefit from them.<ref>{{Cite journal |last1=Berdahl |first1=Carl Thomas |last2=Baker |first2=Lawrence |last3=Mann |first3=Sean |last4=Osoba |first4=Osonde |last5=Girosi |first5=Federico |date=2023-02-07 |title=Strategies to Improve the Impact of Artificial Intelligence on Health Equity: Scoping Review |journal=JMIR AI |language=en |volume=2 |pages=e42936 |doi=10.2196/42936 |issn=2817-1705 |pmc=11041459 |s2cid=256681439 |doi-access=free|pmid=38875587 }}</ref>
 
== Prescription drug issues ==
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The US, along with New Zealand, make up the only countries in the world that allows [[direct-to-consumer advertising]] of prescription drugs. The [[Food and Drug Administration]] in the United States, mainly under the Federal Food, Drug, and Cosmetic, oversees the advertising of prescription drugs to ensure accurate and truthful communication. In 2015, the [[American Medical Association]] called for the banning of direct-to-consumer advertising because it is linked with increased drug prices.<ref>{{cite press release |url=https://www.ama-assn.org/press-center/press-releases/ama-calls-ban-dtc-ads-prescription-drugs-and-medical-devices |title=AMA calls for ban on direct to consumer advertising of prescription drugs and medical devices |date=November 17, 2015 |author=AMA}}</ref> Physicians, via various FDA surveys, conveyed varying thoughts regarding ads as they believe while patients were getting more involved in their own healthcare, they felt pressured to prescribe specific drugs or felt concern over methods of communication about risks and benefits of the drug.<ref>{{Cite journal |date=November 3, 2018 |title=The Impact of Direct-to-Consumer Advertising |url=https://www.fda.gov/drugs/information-consumers-and-patients-drugs/impact-direct-consumer-advertising |journal=FDA |language=en}}</ref> Still, other evidence cites that there are some benefits to direct-to-consumer advertising, such as encouraging patients to see the doctor, diagnosis of rare diseases, and the removal of stigma associated with the disease.<ref>{{cite journal |vauthors=Ventola CL |date=October 2011 |title=Direct-to-Consumer Pharmaceutical Advertising: Therapeutic or Toxic? |journal=P & T |volume=36 |issue=10 |pages=669–84 |pmc=3278148 |pmid=22346300}}</ref>
 
When healthcare legislation was being written in 2009, the drug companies were asked to support the legislation in return for not allowing importation of drugs from foreign countries.<ref>{{cite news |last1=Hook |first1=Janet |last2=Levey |first2=Noam N. |name-list-style=vanc |date=December 16, 2009 |title=Senate healthcare bill advances with rejection of imported drugs |url=httphttps://articleswww.latimes.com/2009archives/la-xpm-2009-dec/-16/nation/-la-na-health-senate16-2009dec16-story.html |access-date=May 4, 2010 |work=Los Angeles Times}}</ref> There were and are many complications regarding drug legislation due to the relationship between pharmaceutical companies and the federal government. Legislation relating to drug prices in particular tends to cause several issues.<ref>{{Cite journal |last1=Ahmadiani |first1=Saeed |last2=Nikfar |first2=Shekoufeh |date=2016-05-04 |title=Challenges of access to medicine and the responsibility of pharmaceutical companies: a legal perspective |journal=DARU Journal of Pharmaceutical Sciences |language=en |volume=24 |issue=1 |pages=13 |doi=10.1186/s40199-016-0151-z |doi-access=free |issn=2008-2231 |pmc=4855755 |pmid=27141958}}</ref> The [[Inflation Reduction Act of 2022]], while still undergoing negotiations for roughly the next two years, attempts to renegotiate drug prices by amending the non-interference clause in the Medicare Part D program.<ref>{{Cite web |last1=Cubanski |first1=Juliette |last2=Neuman |first2=Tricia |last3=Published |first3=Meredith Freed |date=2023-01-24 |title=Explaining the Prescription Drug Provisions in the Inflation Reduction Act |url=https://www.kff.org/medicare/issue-brief/explaining-the-prescription-drug-provisions-in-the-inflation-reduction-act/ |access-date=2024-05-10 |website=KFF |language=en-US}}</ref> The non-interference clause states that the government is prohibited from interfering in negotiations with drug manufacturers, insurers and pharmacies.<ref>{{Cite web |date=2022-09-06 |title=Medicare – Part D Non-Interference Clause {{!}} Chronic Care Policy Alliance |url=https://chroniccarealliance.org/priority-issues/medicare-part-d-non-interference-clause/ |access-date=2024-05-10 |language=en-US}}</ref>
 
== Healthcare reform debate ==
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* [http://www.cms.hhs.gov/NationalHealthExpendData/01_Overview.asp National Health Expenditure Data (US)] from the [[United States Department of Health and Human Services|HHS]]
* [https://www.who.int/countries/usa/en/ US] profile from the [[World Health Organization|WHO]]
* [https://axelreports.com/industry-analysis/global-blood-purification-equipment-market/206711 And Pharma Market Research Report] {{Webarchive|url=https://web.archive.org/web/20230412053500/https://axelreports.com/industry-analysis/global-blood-purification-equipment-market/206711 |date=April 12, 2023 }}
* [https://www.healthcaremailing.com/resources.html Healthcare Market Resources]
* {{curlie|Regional/North_America/United_States/Health|Health Care in the United States}}
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