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2002 OECD Economic Surveys: United States 2002

image of OECD Economic Surveys: United States 2002

This 2002 edition of OECD's periodic survey of the US economy examines recent economic developments, policies and prospects. The special chapter focuses on health system reform and an annex examines September 11 impact on financial markets.

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Health System Reform

The US health care system is unique in the OECD area. It does not have a national insurance programme and 14 per cent of the population has no insurance coverage, although charity and subsidised programmes facilitate access to the medical system for the 40 million uninsured. It spends vastly more than other Member countries (14 per cent of GDP as compared with an OECD average of 8 per cent). It does relatively well in terms of clinical outcomes achieved. It is also responsive, adapting quickly to changes in consumer preferences, and the majority of Americans is highly satisfied with the care they receive. But, the costs of health care are high, and many Americans are at risk of being uninsured at some point in their lives. Also, like in other OECD countries, service use and health outcomes vary widely across the population. Neither public nor private payers have achieved much in the way of curbing expenditure growth over the long term, despite short-lived successes on the public side in containing prices through prospective payment systems and on the private side in controlling volume and costs through managed care. In addition, the system’s performance on various measures of health status, in comparison with those of other OECD countries, calls into question the value of the high level of spending in terms of marginal improvements in population health, although arguably worse societal risk factors also play a role. Still, despite the remaining potential to achieve better value for money, improvements in population health seem to have yielded substantial increases in national income (Nordhaus, 2002b).

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