United States

The U.S. healthcare system is a complex mixture of government-insured and privately-insured services. According to the Centers for Medicare & Medicaid Services, in 2009, 27% of U.S. expenditures on health care were paid for by the federal government, 16% by state and local governments, 21% by private businesses for their employees, and 28% by households directly.

The federal government pays for healthcare primarily from two programs—Medicare and Medicaid. Medicare provided health insurance for 48 million enrollees as of 2010. 40 million of these enrollees were over 65 years of age; 8 million wereyounger people with disabilities. Medicaid is a joint federal and state program for lower income people and families, administered by the states. In 2008, 49 million people received Medicaid benefits. Around 9 million people are covered by both Medicare and Medicaid—termed “dual-eligibles”. This population represents some of the sickest enrollees, and receives a disproportionately large percentage of the programs’ benefits.

Most Americans under 65 receive private health insurance coverage through group coverage plans sponsored by their employers. In most cases, whether health insurance is provided by public or private insurers, the enrollee will still be responsible for some direct costs in the form of deductibles or co-payments.

An analysis by Kaiser Permanente in 2009 showed that of every dollar spent on health care in the U.S., 31 cents was spent on hospital care, 21 cents on physician services or clinical services, 10 cents on pharmaceuticals, and 6 cents on in-patient long term care.