Spending a staggering $4.5 trillion annually and delivering some of the most expensive and unequal health outcomes in the developed world, the United States healthcare system is a behemoth of contradictions, defined as much by its groundbreaking innovation as by its profound disparities and soaring costs.
Key Takeaways
- In 2022, national health expenditures in the United States totaled $4.5 trillion, representing 17.3% of the nation's Gross Domestic Product.
- Per capita health spending in the US reached $12,914 in 2022, more than double the average of comparable OECD countries.
- Prescription drug spending accounted for 9.0% of total national health expenditures in 2022, amounting to $405.5 billion.
- In 2021, 8.6% of Americans, or 28.9 million people, were uninsured.
- Medicaid covered 85.2 million people in FY 2022, including expansions under the ACA.
- Employer-sponsored insurance covered 155 million non-elderly adults in 2022.
- 86.5% of US adults had a usual source of care in 2022.
- 24.1% of adults delayed medical care due to cost in 2022.
- Rural Americans are 20% less likely to have a primary care physician compared to urban.
- Life expectancy at birth in the US was 77.5 years in 2022, below pre-pandemic levels.
- Infant mortality rate was 5.44 per 1,000 live births in 2022.
- Age-adjusted cancer death rate fell to 146.4 per 100,000 in 2021.
- Active physicians per 1,000 population: 2.6 in US vs. 3.5 OECD average.
- Nurse practitioners: 355,000 licensed in 2023.
- Registered nurses: 3.3 million employed in 2022.
US healthcare spending is extraordinarily high yet leaves many Americans underinsured and without adequate care.
Access to Care
- 86.5% of US adults had a usual source of care in 2022.
- 24.1% of adults delayed medical care due to cost in 2022.
- Rural Americans are 20% less likely to have a primary care physician compared to urban.
- Emergency department visits totaled 139 million in 2022.
- Only 56% of US adults received recommended preventive services in 2021.
- 11.2% of children lacked a usual source of care in 2022.
- Telehealth utilization surged to 43% of adults post-pandemic in 2022.
- 78 million Americans live in primary care Health Professional Shortage Areas.
- Average wait time for new patient specialist appointment is 26 days nationally.
- 28% of low-income adults skipped needed care due to cost in 2022.
- Dental care access: 65 million Americans live in dental HPSAs.
- Mental health treatment gap: 15 million adults with serious mental illness untreated.
- 40% of rural hospitals are at risk of closure due to access issues.
- Mammography screening rates: 78.4% of women aged 50-74 in 2020.
- Colorectal cancer screening: 72.5% of adults 45-75 in 2021.
- 19% of adults report trouble finding a new primary care provider.
- Home health care recipients numbered 12 million in 2022.
- 50% of Americans live within 10 miles of a hospital emergency department.
- 37.1% of adults had PCP visit in past year 2022.
- Cost-related avoidance of prescriptions: 18% adults 2022.
- Mental health provider shortage areas cover 107 million.
- Outpatient visits: 919 million in 2021.
- Unmet dental needs due to cost: 12% adults.
- Average time to mental health appt: 25 days.
- 1 in 5 adults report fair/poor access to specialists.
- FQHC visits: 140 million in 2022.
- Vision care access: 30% skipped due to cost.
- Postpartum care within 21 days: only 54% receive.
- Urgent care centers: 11,000 nationwide 2023.
- Cancer screening disparities: Black women 68% mammograms.
- Long-term care waitlists: 600,000 for Medicaid HCBS.
- Pharmacy deserts affect 1 in 8 rural residents.
- Pediatric wait times average 27 days new patient.
- Hospice care access: 1.55 million beneficiaries 2021.
- Avoided care due to transportation: 6% adults.
Access to Care Interpretation
The American healthcare system presents a paradox of high-tech convenience and profound neglect, where most people have a doctor in theory but face a gauntlet of delays, costs, and shortages that force them to gamble with their health until an emergency makes the choice for them.
Insurance and Coverage
- In 2021, 8.6% of Americans, or 28.9 million people, were uninsured.
- Medicaid covered 85.2 million people in FY 2022, including expansions under the ACA.
- Employer-sponsored insurance covered 155 million non-elderly adults in 2022.
- Medicare enrolled 65.0 million beneficiaries in 2023, with 50.1 million in traditional Medicare.
- Marketplace enrollment under the ACA reached a record 21.3 million in 2024.
- 91.4% of the US population had health insurance coverage in 2022.
- Children under 19 had an uninsured rate of 5.4% in 2022, down from 9.4% pre-ACA.
- TRICARE and other VA/DoD coverage served 9.3 million people in 2022.
- Direct-purchase insurance covered 10.5 million non-elderly adults in 2022.
- Uninsured rate among non-elderly adults dropped to 9.3% in 2022 from 16.0% in 2010.
- 27.4 million nonelderly individuals remained uninsured in 2022 despite ACA gains.
- Medicaid/CHIP covered 38% of US children under 19 in FY 2022.
- Average Marketplace premium before subsidies was $591 per month in 2023.
- 93% of Marketplace enrollees received premium tax credits in 2023.
- Medicare Advantage enrollment hit 31 million in 2023, 51% of beneficiaries.
- In 2022, 13.9% of non-elderly Black Americans were uninsured, compared to 7.9% of whites.
- Hispanic uninsured rate was 18.2% for non-elderly in 2022.
- 92 million Americans were underinsured in 2022, facing high out-of-pocket costs.
- In 2021, 41% of working-age Americans were inadequately insured.
- CHIP enrollment stood at 9.1 million children in FY 2022.
- Uninsured rate for adults 18-64: 11.1% in 2023.
- 14.5 million enrolled in Medicaid expansion by 2023.
- Employer coverage stability: 49% of firms offer in 2023.
- Dual-eligible Medicare-Medicaid: 12.4 million in 2022.
- Off-Marketplace individual coverage: 5.5 million in 2022.
- Coverage gains reversed slightly: uninsured up 1 million 2022-2023.
- Asian American uninsured rate: 5.1% non-elderly 2022.
- Short-term plans cover 3 million, often inadequate.
- Average silver plan premium: $456/month pre-subsidy 2024.
- Medicaid disenrollment post-unwinding: 20 million by 2024.
- Employer plans cover 180 million total lives 2023.
- AIAN uninsured rate: 19.1% non-elderly 2022.
- Underinsured defined as spending >10% income on premiums.
- VA coverage: 9.1 million veterans enrolled 2023.
- 25% of uninsured cite cost as main barrier 2023.
- 8.4% uninsured rate overall in first half 2023.
Insurance and Coverage Interpretation
While we've heroically patched together a quilt of coverage that now drapes over 91.4% of Americans, the remaining threads—27.4 million still uncovered, rampant underinsurance, and stark racial disparities—reveal a fabric that is still uncomfortably threadbare for far too many.
Quality and Outcomes
- Life expectancy at birth in the US was 77.5 years in 2022, below pre-pandemic levels.
- Infant mortality rate was 5.44 per 1,000 live births in 2022.
- Age-adjusted cancer death rate fell to 146.4 per 100,000 in 2021.
- Maternal mortality ratio was 32.9 deaths per 100,000 live births in 2021.
- Heart disease remains the leading cause of death, with 695,000 deaths in 2022.
- US ranks last among 11 high-income countries in amenable mortality.
- Hospital-acquired infections affect 1 in 31 patients, costing $45 billion annually.
- 30-day hospital readmission rate for Medicare patients is 15.3%.
- Avoidable hospitalizations per 100,000 population: 1,800 in US vs. 500 in top countries.
- Obesity prevalence among adults: 41.9% in 2021-2023.
- Diabetes prevalence: 14.7% of adults, or 38.4 million in 2022.
- Opioid overdose deaths: 81,806 in 2022.
- Suicide rate: 14.2 per 100,000 in 2021.
- Hospital patient safety grade: Only 30% of hospitals earn A from Leapfrog.
- Postoperative mortality within 30 days: 1.4% for elective surgery.
- Breast cancer 5-year survival rate: 91.1% in US.
- Stroke death rate: 37.2 per 100,000 in 2022.
- Alzheimer's disease deaths: 119,399 in 2021.
- COVID-19 deaths totaled 1.1 million through 2023.
- Preventive care effectiveness: 55% adherence to USPSTF recommendations.
- Drug overdose death rate 32.6 per 100k 2022.
- Preterm birth rate 10.41% in 2022.
- Kidney disease death rate 14.5 per 100k.
- HCAHPS scores: 73% rate hospital 9-10.
- Sepsis mortality: 15-30% in hospitals.
- COPD death rate 41.0 per 100k 2022.
- 5-year survival for prostate cancer: 97.1%.
- Influenza deaths average 34,000 annually.
- Central line infections reduced 44% since 2015.
- Low birthweight rate 8.52% 2022.
- Firearm homicide rate 6.5 per 100k 2021.
- C. diff infections: 29,000 deaths yearly.
- Melanoma survival 5-year: 94.4%.
- Unintentional injury death rate 61.6 per 100k.
- Palliative care availability in 87% of hospitals.
- Child mortality rate under 5: 6.0 per 1k.
- HIV death rate 1.9 per 100k 2021.
- Hospital mortality index average 0.95.
Quality and Outcomes Interpretation
The American healthcare system is a dazzling paradox where we can perform medical miracles on demand while simultaneously failing at the fundamentals, like keeping people alive longer than the 1980s, not infecting them when they come for help, or preventing them from needing to come at all.
Spending and Costs
- In 2022, national health expenditures in the United States totaled $4.5 trillion, representing 17.3% of the nation's Gross Domestic Product.
- Per capita health spending in the US reached $12,914 in 2022, more than double the average of comparable OECD countries.
- Prescription drug spending accounted for 9.0% of total national health expenditures in 2022, amounting to $405.5 billion.
- Hospital care expenditures grew by 6.5% in 2022 to $1.3 trillion, driven by increased utilization post-COVID.
- Medicare spending increased by 6.6% to $944.3 billion in 2022, representing 21% of total NHE.
- Private health insurance spending rose 10.7% to $1.3 trillion in 2022, the fastest growth since 1984.
- Out-of-pocket spending by Americans was $433.7 billion in 2022, or 9.7% of total health expenditures.
- Administrative costs in the US healthcare system consume about 8% of total health spending, compared to 1-3% in other countries.
- The average family health insurance premium in 2023 was $23,968, up 7% from 2022.
- US healthcare spending per capita is projected to reach $14,160 by 2031.
- In 2022, national health expenditures grew 4.1% to $4.5 trillion.
- Retail prescription drugs cost $461 billion in 2023 projections.
- Medicaid spending grew 9.7% to $824 billion in 2022.
- Physician and clinical services spending: $807 billion in 2022.
- Nursing care facilities spending up 4.3% to $175 billion.
- Health spending growth averaged 4.5% annually 2018-2022.
- US spends 31% more on admin than Canada per capita.
- Average deductible for single coverage: $1,735 in 2023.
- Hospital prices rose 47% from 2001-2020.
- Freestanding ER spending per visit: $1,794 vs. $1,309 hospital.
Spending and Costs Interpretation
We are spending twice as much as other wealthy nations for a system where nearly a fifth of every dollar goes to healthcare, a growing share of our paychecks gets devoured by insurance premiums, and the only thing outpacing our spending is our administrative paperwork.
Workforce
- Active physicians per 1,000 population: 2.6 in US vs. 3.5 OECD average.
- Nurse practitioners: 355,000 licensed in 2023.
- Registered nurses: 3.3 million employed in 2022.
- Physician shortage projected at 37,800-124,000 by 2034.
- 47% of physicians reported burnout in 2022.
- Dental hygienists: 213,000 in 2022.
- Pharmacists: 330,000 employed in 2022.
- Home health aides: 4.1 million in 2022.
- Average physician age: 52.5 years in 2022.
- International medical graduates comprise 25% of US physicians.
- Nurse turnover rate: 27.2% in hospitals in 2022.
- Primary care physicians: 93.9 per 100,000 population.
- Psychiatrists: 12.0 per 100,000 adults.
- OB/GYNs: 25.6 per 100,000 women aged 15-44.
- Rural physician shortage: 60.7 per 100,000 vs. 84.5 urban.
- Medical residents: 140,000 in ACGME programs in 2023.
- Physician assistants: 148,000 in 2022.
- Turnover intent among nurses: 31% plan to leave in 2023.
- 76% of physicians are employees, up from 60% in 2019.
- Average annual wage for physicians: $239,200 in 2022.
- RN median wage: $81,220 in 2022.
- Active dentists: 200,000 in 2022.
- Optometrists: 42,000 practicing.
- Physical therapists: 258,000 in 2022.
- Burnout among nurses: 62% in 2022.
- Geriatricians shortage: only 7,000 for 50 million seniors.
- Surgical specialists: 20% of physician workforce.
- LPNs: 657,000 employed 2022.
- Rural nurse shortage: 17% vacancy rate.
- IMG retention: 80% stay post-residency.
- Midwives: 13,000 certified 2023.
Workforce Interpretation
While we are training an army of nurses and assistants to fill the ranks, we are simultaneously bleeding them dry through burnout and high turnover, all while our aging core of doctors shrinks relative to demand, creating a healthcare system frantically trying to build a house while half the builders are quitting and the architects are retiring.
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