US health system getting worse
US Healthcare and insurance
The problems of the US healthcare system are growing, warns an expert in this week's BMJ.
The United States is the only major industrialised nation without universal health insurance, writes Karen Davis, President of the Commonwealth Fund. Coverage varies widely between states and has deteriorated in recent years. The number of people without health insurance has increased from 40 million in 2000 to nearly 47 million in 2005.
Gaps in coverage lead to inequalities in access to care, poor quality care, lost economic productivity, and avoidable deaths.
The Institute of Medicine estimates that 18,000 lives are lost annually as a consequence of gaps in coverage. It calculates the annual cost of achieving full coverage at $34bn - $69bn, which is less than the loss in economic productivity from existing coverage ($65bn - $130bn annually).
Furthermore, expanding health insurance coverage would disproportionately help people on low incomes, who make up two thirds of the uninsured, thus increasing equity in access to health care and health outcomes, says Davis.
Several states have enacted plans to make