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Health Care Reform in the United States


  • David Carey


  • Bradley Herring

    (Johns Hopkins University)

  • Patrick Lenain



In spite of improvements, on various measures of health outcomes the United States appears to rank relatively poorly among OECD countries. Health expenditures, in contrast, are significantly higher than in any other OECD country. While there are factors beyond the health-care system itself that contribute to this gap in performance, there is also likely to be scope to improve the health of Americans while reducing, or at least not increasing spending. This paper focuses on two factors that contribute to this discrepancy between health outcomes and health expenditures in the United States: inequitable access to medical services and subsidized private insurance policies; and inefficiencies in public health insurance. It then suggests two sets of reforms likely to improve the US health-care system. The first is a package of reforms to achieve close to universal health insurance coverage. The second set of reforms relates to payment methods and coverage decisions within the Medicare programme to realign incentives and increase the extent of economic evaluation of different medical procedures. Réforme du système de santé aux États Unis Malgré certains progrès, les États-Unis ne sont pas très bien placés parmi les pays de l’OCDE pour ce qui est de diverses mesures des résultats de la santé. Or, les dépenses de santé y sont sensiblement plus élevées que dans tout autre pays de l’OCDE. Cette situation contradictoire amène à penser qu’il est possible d’améliorer le système de santé du pays tout en réduisant, ou du moins en n’augmentant pas, les dépenses. Le présent papier examine plus particulièrement deux facteurs qui contribuent à la divergence entre les résultats et les dépenses en matière de santé aux États-Unis : accès inéquitable aux services médicaux et inefficience des subventions pour la souscription de polices d’assurance privées ; et manque d’efficacité de l’assurance de santé publique. Il propose ensuite deux séries de réformes propres à améliorer le système de santé des États-Unis. La première est un ensemble de mesures destinées à assurer la couverture universelle de l’assurance-maladie. La deuxième concerne les méthodes de paiement et les décisions de prise en charge au sein du programme Medicare et vise à réaligner les incitations et à renforcer l’évaluation économique des différents actes médicaux.

Suggested Citation

  • David Carey & Bradley Herring & Patrick Lenain, 2009. "Health Care Reform in the United States," OECD Economics Department Working Papers 665, OECD Publishing.
  • Handle: RePEc:oec:ecoaaa:665-en

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    References listed on IDEAS

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    More about this item


    adverse selection; aléa moral; assurance santé; avantage Medicare; comparaison de l’efficacité; comparative effectiveness; coûts de santé; dépenses de santé; espérance de vie; exonération fiscale; health costs; health expenditure; health oucomes; health status; health subsidies; individual market; life expectancy; mandat; mandate; marché individuel; Medicare; Medicare advantage; moral hazard; pooling; regroupement de risque; résultats de la santé; subventions pour l’achat des polices d’assurance santé; sélection adverse; tax exclusion;

    JEL classification:

    • C23 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Models with Panel Data; Spatio-temporal Models
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • O57 - Economic Development, Innovation, Technological Change, and Growth - - Economywide Country Studies - - - Comparative Studies of Countries

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