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The United States spends the most on health care, with total public and private health spending totaling $3.4 trillion in 2016. This represents about 18 percent of GDP, exceeding $10,000 per capita. Total spending on health is expected to grow by 59 percent over the next nine years, which is higher than GDP growth, which will raise the share of health spending to around 20 percent of GDP in 2025. The increase will be mainly caused by expected inflation in services and health prices, which will exceed the overall price growth. The federal and local governments' share of health spending is $1.5 trillion, with families and the private sector bearing the rest.
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Despite massive spending on healthcare, the United States has neither a unified healthcare system nor universal coverage for the entire population. America uses a mix of health systems. The federal government funds some health care programs for many residents and its civilian and military institutions, and it also supports state and local governments in other health programs.
It is reported that families and employers are responsible for providing health coverage to more than half of the population. According to 2014 data on health spending, families bear about 28 percent of all health spending in the United States, while employers pay about 20 percent. The federal government funded about 28 percent of total health spending, while state and local governments paid about 17 percent.
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More than 150 million people get health coverage from the employers and about 90 million people own their own resources, and the employers usually pay the largest portion, while the employee bears the rest. On the other hand, federal, provincial, and local governments finance health care through public programs that target specific population groups. The most important of these programs:
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- 1- Medicare retired healthcare program that covers healthcare costs for people over the age of 65 and young adults with permanent disabilities. Spending on the program last year exceeded $700 billion. The program is financed by taxes on wages and income and from contributions and benefits on the fund designated for it, and 57 million people benefit from it.
- 2- Medicaid is run by state governments, which designate many of their regulations within their spheres of influence. Its costs are shared by both the federal and state governments and it provides coverage to approximately 71 million people whose resources do not allow purchasing private coverage. The program limits the beneficiaries' entry to no more than 130 percent of the poverty line, and there are other conditions for eligibility for this program. Currently, total spending on this program is about $575 billion, more than half of which are borne by the federal government, and the rest by the state and some local governments.
- 3- The Children's Health Insurance Program, which provides health coverage for children from families with limited resources, but whose income exceeds the upper limit to qualify for Medicaid. This program is run by state governments and with central government support, and this program will end in 2019.
- 4- The Veterans Program provides health coverage for veterans. A specialized government department operates hospitals, health centers, and shelters for elderly combatants and their families. Some reports indicate that the services of the health institutions of this department are more comfortable for patients from the private sector.
- 5- Military healthcare program, which provides health services to employees and retirees in the US armed forces and their families, and is similar to other health systems for armies around the world that run medical institutions that provide health services in combat and in peacetime. This system is operated by hospitals, health centers, and dental clinics to serve the military and their families, who are estimated to number about ten million people.
- Responsibility 6 - The health coverage program for federal government employees, whereby the federal government, as an employer, bears the costs of three-fourths of health insurance while employees bear the rest. Many states, cities, and regions offer medical insurance programs for their employees.