1.5 Chapter Summary
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 & 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. Private sector stakeholders also 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 primarily for adults age 65 and older and certain younger people with disabilities, while Medicaid provides coverage for eligible low-income individuals and families. Nevertheless, most Americans receive coverage from private insurance, which is mostly provided through the workplace. A key 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 health and wellness can be seen in measures such as mortality and productivity. For example, the leading cause of mortality in 2024 was heart disease, and poor health 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 2024, life expectancy at birth in the United States was 79.0 years, cancer was the second leading cause of death, and the infant mortality rate was approximately 5.5 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.
Life expectancy and overall health have improved in recent years for most Americans. However, by 2060, nearly one in four Americans will be age 65 or older, creating greater demands for healthcare, in-home caregiving, and assisted living facilities. Socioeconomic factors such as income, employment, education, health insurance coverage, and access to resources can contribute to differences in health outcomes and access to healthcare. Social determinants of health, or the conditions in the environments where people are born, live, learn, work, play, worship, and age, are an important focus of Healthy People 2030. The five social determinants of health domains are economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context.
Key terms included in this chapter are also listed in the Glossary at the end of the book.
