The United States (U.S.) healthcare system is highly complex, not only due to the country’s large population and size but also because there are multiple insurers and delivery systems. Regulatory systems are divided between federal, state, and local governments and many private organizations. Key private organizations, particularly most health insurers, operate on a for-profit basis. The key federal agency is the Department of Health and Human Services, which oversees the Medicare and Medicaid programs through its Centers for Medicare and Medicaid Services. Other key agencies include the National Institutes of Health, the Centers for Disease Control and Prevention, the Veterans Health Administration, and the Food and Drug Administration. In addition, private sector stakeholders play a strong role in the system. The private sector led the development of the health system before the Second World War, with the major federal government health insurance programs, Medicare and Medicaid, only arriving in the mid-1960s. Medicare provides coverage for seniors and some of the disabled, and Medicaid covers healthcare services for some of the poor and near-poor. Nevertheless, most Americans receive coverage from private insurance, which is mostly provided through the workplace. A key, relatively recent reform was the Patient Protection and Affordable Care Act of 2010. Its major provisions were implemented in 2014 and included both publicly and privately funded insurance coverage expansions.
Achieving wellness requires a person to have physical, emotional, intellectual, spiritual, social, and environmental health. The impact of our healthcare choices can be seen in terms of mortality rate and productivity. For example, the top leading cause of mortality in 2020 was heart disease, and being unhealthy can lead to absenteeism, disability, or reduced work output. Health indicators are used to describe and monitor a population’s health status. Three common health indicators include life expectancy, deaths from cancer, and infant mortality. In 2020, life expectancy at birth in the United States was 77.0 years, cancer was the second leading cause of death, and the infant mortality rate was 5.42 deaths per 1,000 live births. In terms of healthcare, there are clear distinctions between medical practitioners and public health professionals. Medical practitioners treat individual patients and teach people how to care for themselves. In contrast, public health professionals work to prevent the spread of communicable diseases, manage public health hazards, and respond to natural or man-made disasters.
Even though life expectancy and overall health have improved in recent years for most Americans, not all older adults benefit equally. Vulnerable populations include patients who are elderly, racial or ethnic minorities, elderly, socioeconomically disadvantaged, uninsured or those with certain medical conditions. By 2060, nearly one in four Americans will be 65 years and older creating greater demands for healthcare, in-home caregiving, and assisted living facilities. Health disparities still exist for some people from racial and ethnic minority groups. The least healthy counties in the U.S. have greater poverty rates, uninsured people, and unemployment than the rest of the country. Social determinants of health, or the conditions in which people are born, grow, live, work, and age, are one of three priority areas for Healthy People 2030, along with health equity and health literacy.
Key terms included in this chapter are also listed in the Glossary at the end of the book.