The US Health Care (Non)System: The Personal Assessment of an American Radiologist

Abstract

It would be convenient to say that the US health care system is a reflection of the character of the American peopleddiverse, creative, entrepreneurial, ‘‘can do.’’ It is not that simple. In point of fact, there is no US health care system. Rather, the organization, financing, and delivery of our medical care are a patchwork that has grown over time and in response to temporal demands. In not having a clearly defined, integrated health care system, the United States is unusual among developed countries. That this is the case has implications for the American populace, which I will address in this article. My goal is to provide insight to Canadian radiologists, which may help them to evaluate their own system of care in the context of another. At the second annual American College of Radiology Forum, an event drawing together multidisciplinary experts on a selected topic, then National Quality Forum President, Dr Kenneth Kiser, described what he called ‘‘the US health care paradox’’[1]. The United States has an abundance of highly trained practitioners, state-of-the-art technologies, and unequaled health care spending. Despite this, care is difficult to access, fragmented, unevenly distributed, and much of the care provided is of uncertain value. As a result, he noted, there is a ‘‘quality gap,’’ characterized by overuse, underuse, misuse, and waste [1]. The Institute of Medicine has concluded that simply tinkering with the current nonsystem is insufficient to cure our problems and that sweeping change is needed [2]. Dr Kiser’s indictments to the contrary, the majority of Americans receive high-quality medical care. Nonetheless, there is a growing consensus, to which I subscribe, that how we deliver health care in the United States is flawed, such that our society pays too much for its health care. The continuing rate of increase in expenditures as a share of our economy (16.3% of the gross domestic product in 2007) is