How the Healthcare System Operates in the United States


Healthcare permeates the life of every individual in the modern world. However, as with any popular subject, there are numerous misconceptions about what it is. In order to understand the healthcare system, it is essential to know how it is structured. The healthcare system is defined a set of interrelated and interacting regulatory legal acts, sources of healthcare financing, types of medical care, bodies, and organizations that manage and receive medical care. As each country evolved in a unique way so did national healthcare. Subsequently, each country has unique strengths as well as unique problems in delivering healthcare. Understanding how the healthcare system operates in the United States is essential in ascertaining how it addresses inequity.

Overview of Providers

The most important component of the healthcare system is a healthcare provider. Usually, it is an organization. The most common form is a clinic, which offers non-emergency healthcare services. A larger entity is a hospital, where intensive and emergent care is provided. Sometimes, a number of physicians form a single entity known as a medical group. An even larger form is a health system, which delivers healthcare to a specific population. The largest entity is a hospital network. However, people can also be healthcare providers, the most common of whom are physicians. Advanced practice providers, such as nurses, provide a narrower range of services. Non-physician care is handled by allied health professionals. Finally, any person in the industry but not one of three described categories is a health professional.

The problem that permeates the US is a drastic healthcare inequity. Simply put, it means that not everyone has equal access to medical services. Naturally, each provider pursues their own policy regarding clients. However, some common tendencies at alleviating inequality can be observed. For example, clinics, hospitals, and hospital networks introduce loyalty programs for vulnerable groups (Butcher, 2020). Medical groups and health systems suggest initiatives for health outcomes (Horril et al., 2022). Physicians and advanced practice providers may offer new policies and advocate equality (Gondi & Song, 2019). Meanwhile, allied health professionals and health professionals contribute to disparities’ elimination by engaging in organizations promoting patient safety and equality (Gondi & Song, 2019).

Overview of Settings

Aside from providers, healthcare settings may also contribute to resolving the problem of inequality. Five settings are identified: hospitals, outpatient clinics, longterm care facilities, clinical labs, and hospices. In hospitals, professionals provide diagnostic examination and treatment to patients who have health issues requiring immediate medical attention. When health problems do not necessitate hospital admittance, short-term treatment is administered in outpatient clinics. When patients have substantial disabilities, they are placed in long-term care facilities. None of these entities would function without clinical labs that perform medical tests. When it is clear that patients are near death, they are placed in hospices.

Each setting can help address inequality in its own way. For example, hospitals participate in public health policy-making, where they promote inclusion of disenfranchised patients (Gondi & Song, 2019). Meanwhile, outpatient clinics and clinical labs serve patients without insurance, thereby allowing all people receive medical services regardless of socioeconomic, cultural, and other factors (Edwards et al., 2020). Long-term care facilities and hospices use the revenues generated from expensive medical services to finance patients who do cannot pay for their care (Butcher, 2020). Combined together, settings make the healthcare system more accessible.

Overview of Purchasers

The second participant of the healthcare industry is the purchaser. Any person or entity that requires medical services or expects them has to obtain an insurance, which will cover for some amount of financial losses. Within this context, two purchasers are identified: the government and the individual purchaser. Whenever a person is employed in a federal agency, their health insurance is payed for by the government. Similarly, some medical services can be provided without an insurance precisely because the government has purchased them. An individual purchaser is a person or organization who buys insurance, which allow them to hedge financial expense on healthcare.

Insurance providers are interested in having more clients purchase their insurances. Subsequently, providers create less strict eligibility criteria (Gondi, S., & Song, 2019). Government engages in tackling the issue of inequality directly by implementing appropriate state programs. By adjusting the existing legislation and influencing the purchasing power of population, the government allows different social and cultural groups access the care (Horrill et al., 2022; Jilani et al., 2021). Individual purchasers also participate despite their limited influence. An example would be public speeches, private promotional campaigns, and other ways of increasing public awareness.


Butcher, L. (2020). The future of private equity in healthcare. Physician Leadership Journal, 7(4), 57-60.

Edwards, T. L., Breeyear, J., Piekos, J. A., & Edwards, D. R. V. (2020). Equity in health: consideration of race and ethnicity in precision medicine. Trends in Genetics, 36(11), 807-809.

Gondi, S., & Song, Z. (2019). Potential implications of private equity investments in health care delivery. Jama, 321(11), 1047-1048.

Horrill, T. C, Browne, A. J., Stajduhar, K. I. (2022). Equity-oriented healthcare: What it is and why we need it in oncology. Current Oncology, 29(1), 186-192.

Jilani, M. H., Javed, Z., Yahya, T., Valero-Elizondo, J., Khan, S. U., Kash, B., & Nasir, K. (2021). Social determinants of health and cardiovascular disease: current state and future directions towards healthcare equity. Current Atherosclerosis Reports, 23(9), 1-11.

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