Abstract

The organization and financing of health care in the United States differ markedly from the arrangements in most other developed countries, which employ integrated systems to deliver a core set of medical benefits to nearly all their residents. In contrast, the United States has a fragmented and convoluted delivery system with overlapping responsibilities across programs and serious gaps in coverage. Most non-elderly Americans receive health insurance through an employer-sponsored plan. The federal government provides insurance for some groups not easily covered through employer arrangements - the elderly, the disabled, recipients of income support, and poor children. This paper first describes how the U.S. arrived at the myriad arrangements it currently uses and then outlines the eligibility and financing arrangements for the major sources of insurance coverage: Medicare, Medicaid, and employer-based plans. The paper then outlines how medical services are organized and managed in fee-for-service and managed care. Finally, the paper describes emerging markets for health insurance that might provide a template for a more integrated U.S. health system.