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The US Health System: An Assessment and Prospective Directions for Reform


  • Elizabeth Docteur
  • Hannes Suppanz
  • Jaejoon Woo


This paper assesses the performance of the United States health system in an international context and discusses potential directions for reform. The US health system is unique among OECD countries in its heavy reliance on the private sector for both financing and delivery of health care. The public sector plays a not-insignificant role, providing coverage for the elderly, disabled and poor, and spending as much on health as a share of GDP as is spent in total by many OECD countries. The system is considered highly flexible, capable of evolving quickly to address the changing preferences of consumers and the incentives put in place by the requirements of payers and government regulation. It is also characterised by excellent access by the insured population to the latest advances in medical technology. However, 14 per cent of Americans lack insurance coverage, and the decentralised, multi-payer approach to financing and regulation provides relatively few levers to control ... Le système de santé des États-Unis : Evaluation et lignes directrices possibles pour une réforme Ce document évalue les performances du système de santé des États-Unis dans un contexte international et examine les directions potentielles pour une réforme. Le système de santé des États-Unis est sans équivalent dans la zone de l’OCDE, en ce sens qu’il dépend essentiellement du secteur privé à la fois pour le financement et la fourniture des soins de santé. Le secteur public joue un rôle non négligeable en procurant une couverture pour les personnes âgées, les handicapés et les pauvres et consacre autant pour la santé en part de PIB que ce que consacrent beaucoup de pays de la zone de l’OCDE pour l’ensemble des dépenses de santé. Le système est reconnu très souple, capable d’évoluer rapidement pour répondre aux changements dans les attentes des consommateurs, aux incitations mises en place par les exigences des payeurs et à la réglementation publique. Il est aussi caractérisé par un excellent accès aux dernières avancées technologiques en matière médicale pour la population ...

Suggested Citation

  • Elizabeth Docteur & Hannes Suppanz & Jaejoon Woo, 2003. "The US Health System: An Assessment and Prospective Directions for Reform," OECD Economics Department Working Papers 350, OECD Publishing.
  • Handle: RePEc:oec:ecoaaa:350-en
    DOI: 10.1787/768340075526

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    Cited by:

    1. Kumpmann, Ingmar, 2009. "Monopolistic Competition and Costs in the Health Care Sector," IWH Discussion Papers 17/2009, Halle Institute for Economic Research (IWH).
    2. Jan Mertl, 2014. "The Impact of Longevity on Health Care Systems," European Research Studies Journal, European Research Studies Journal, vol. 0(1), pages 85-100.
    3. Cacace, Mirella, 2007. "The changing public/private mix in the American Health Care System," TranState Working Papers 58, University of Bremen, Collaborative Research Center 597: Transformations of the State.
    4. Stolpe, Michael, 2003. "Ressourcen und Ergebnisse der globalen Gesundheitsökonomie: Einführung und Überblick," Kiel Working Papers 1177, Kiel Institute for the World Economy (IfW).
    5. Goodman, Steffie, 2007. "Piercing the veil: The marginalization of midwives in the United States," Social Science & Medicine, Elsevier, vol. 65(3), pages 610-621, August.
    6. Greß, Stefan & Walendzik, Anke & Wasem, Jürgen, 2005. "Nichtversicherte Personen im Krankenversicherungssystem der Bundesrepublik Deutschland: Bestandsaufnahme und Lösungsmöglichkeiten," IBES Diskussionsbeiträge 147, University of Duisburg-Essen, Institute of Business and Economic Studie (IBES).

    More about this item


    health care; santé; United States; États-Unis;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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