Health Care System Analysis: National, State & Community

Instructor: Daniel Murdock

Daniel has taught Public Health at the graduate level and has a Ph.D. in Behavioral Sciences & Health Education.

In this lesson, we'll examine the state of health care in the U.S. at multiple levels of the health care system. We'll discuss major issues related to health care at the national, state, and community levels.

Assessing Health Care at Multiple Levels

How would you rate the quality of health care in your community? How about in your state? How about in the U.S. overall? For many of us, our answers to these questions might vary quite a bit.

There are many local and regional differences in health and health care in the United States. For a truly nuanced analysis of the U.S. health care system, we need to assess health status and health care at multiple levels.

So that's just what we're going to do! We'll start by examining U.S. health care from a national perspective. Then we'll discuss some major ways in which health care varies across states and communities in the U.S.

Health Care in the U.S.

No other advanced industrialized country has a health care system quite like the U.S. Unlike most economically similar countries, the U.S. does not have a universal health care system that provides coverage for everyone.

The U.S. is also unique in that it does not have a uniform health care system, rather, it is financed through a mix of public and private funds and it is delivered mostly through private providers.

This hybrid system has several important trade-offs. The U.S. system promotes health care innovation and provides state and local governments with greater flexibility in addressing health care at the state and local level. However, the U.S. spends considerably more on health care than other high-income countries, and many Americans do not have any form of health insurance coverage.

Despite higher spending on health care, the U.S. lags behind many economically-similar countries on several key health outcomes. Compared to most other advanced industrialized countries, the U.S. has a lower average life expectancy, higher infant mortality rate, and higher prevalence of chronic diseases.

Comparing Health Care in States

Health care systems can vary widely from state to state. One way in which these systems vary is with respect to the cost of health care. For example, average monthly insurance premiums are over two times higher in Alaska than in Utah.

Some of the biggest differences between states relate to health care access. For example, the District of Columbia has more than four times as many physicians per capita than Idaho or Mississippi.

Over the last several years, 33 total states have expanded their Medicaid programs under the Affordable Care Act to cover more low-income people. States that expanded Medicaid have seen greater gains in health care access in recent years. Many of these states have seen double-digit reductions in their rate of uninsured adults. However, 18 states opted not to expand Medicaid.

Another important way in which health care varies at the state level is with respect to health outcomes. For example, the infant mortality rate in Alabama is more than twice the infant mortality rate in New Hampshire.

Average life expectancy also varies widely from state to state. The average resident of Hawaii can expect to live 81 years, while average life expectancy in Mississippi is only 75 years.

Comparing Communities

We also see differences in health care at the city and county level. Some of the biggest gaps are between rural and non-rural communities. On average, rural communities have higher rates of chronic illness, poorer overall health status, higher uninsured rates, and less access to care.

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