Tristen Slamowitz

Background: Healthcare coverage is defined as a means for financing a person’s healthcare expenses and is intended to reduce barriers to access, protect individuals from unexpected costs, and promote economic instability. In 2021, 8.3% of people living in the United States, or 27.2 million people, did not have health insurance at any point during the year¹. Access to care and cost-related nonadherence are critical challenges for both uninsured and insured individuals. As patient out-of-pocket costs rise, use of clinician visits, diagnostic tests, and medications falls. The United States Healthcare system infrastructure is suffering from breakdowns in care due to financial barriers introduced by ineffective healthcare coverage.

Objective: This literature review intends to explore an alternative framework for healthcare coverage and explicitly identifies and disprove areas of misconception from the common consumer regarding the universal healthcare system.

Search Methods: An online search in the PubMed database was conducted from 2017 to 2023 using the following keywords: “healthcare coverage”, ” united states healthcare system”, “universal healthcare”.

Results: Two commonly understood beliefs were explored in the context of primary resources to determine the merit of these ideologies: Universal healthcare is more expensive and results in worse outcomes. 2017 spending report demonstrated US insurers and providers spent significantly more on healthcare administration than Canada, amounting to 34.2% of national health expenditures compared to 17.0% in Canada². In a randomized policy experiment in the Philippines, interventions that expanded insurance coverage led to a decrease in out-of-pocket spending³. In an economic review across 49 countries, there was only a 13% difference in national income for countries where resources were seen as a binding constraint⁴. High cost of US healthcare can prevent individuals from receiving desired services resulting in delayed treatment and worse outcomes⁵. The U.S. ranks at the bottom on health care outcomes with a  rate of preventable mortality of more than double that of the best-performing country, Switzerland⁶. In a review on COVID-19 outcomes, Americans who were uninsured and underinsured received delayed diagnosis and exacerbated transmission leading to elevated mortality⁷.

Conclusions: In conclusion, there is a need to re-envision the United States healthcare system to address systemic issues introduced by private coverage and barriers to access care. Shift to a single-payer universal healthcare system would provide relief to lower-income households. It is estimated that ensuring healthcare access for all Americans would save over 68,000 lives and 1.73 million life-years every year⁸. Future work entails a focus on the cause of politically charged rhetoric as well as an expanded view into the effectiveness of Universal Healthcare implementation in other developed countries.

Works Cited:

1. Keisler-Starkey, K., & Bunch, L. N. (2022). Health insurance coverage in the United States: 2021. Washington, DC: US Census Bureau. https://www.census.gov/content/dam/Census/library/publications/2022/demo/p60-278.pdf
2. Himmelstein DU, Campbell T, Woolhandler S. Health Care Administrative Costs in the United States and Canada, 2017 [published correction appears in Ann Intern Med. 2020 Sep 1;173(5):415]. Ann Intern Med. 2020;172(2):134-142. doi:10.7326/M19-2818. https://libkey.io/libraries/465/pmid/31905376
3. Wagner N, Quimbo S, Shimkhada R, Peabody J. Does health insurance coverage or improved quality protect better against out-of-pocket payments? Experimental evidence from the Philippines. Soc Sci Med. 2018;204:51-58. doi:10.1016/j.socscimed.2018.03.024. https://pubmed.ncbi.nlm.nih.gov/29574292/
4. McDonnell, A., Urrutia, A., & Samman, E. (2019). Reaching universal health coverage: a political economy review of trends across 49 countries. https://apo.org.au/node/273286
5. Gui, X., & Chen, Y. (2019, May). Making healthcare infrastructure work: Unpacking the infrastructuring work of individuals. In Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems (pp. 1-14). https://dl-acm-org.srv-proxy2.library.tamu.edu/doi/pdf/10.1145/3290605.3300688
6. NEW INTERNATIONAL STUDY: U.S. Health System Ranks Last Among 11 Countries; Many Americans Struggle to Afford Care as Income Inequality Widens. The Commonwealth Fund. 2021. https://www.commonwealthfund.org/sites/default/files/2021-10/Schneider_Mirror_Mirror_2021_PR.pdf
7. Blair, Jenny. Study: More than 335,000 Lives Could Have Been Saved During the Pandemic if U.S. Had Universal HealthCare. Yale School of Public Health. 2022. https://www.pnas.org/doi/10.1073/pnas.2200536119

Galvani AP, Parpia AS, Foster EM, Singer BH, Fitzpatrick MC. Improving the prognosis of health care in the USA. Lancet. 2020;395(10223):524-533. doi:10.1016/S0140-6736(19)33019- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572548/