RT Journal
A1 Bible, Jesse E.
A1 Lee, Richard S.
A1 Friedlaender, Gary E.
T1 The Need for Increased Access to the U.S. Health-Care System
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2009
FD February 1
VO 91
IS 2
SP 476
OP 484
DO 10.2106/JBJS.H.00735
UL http://dx.doi.org/10.2106/JBJS.H.00735
AB 
Health-care costs in the United States are rising at an alarming rate. Despite increasing national spending, health-care access remains an important issue to many Americans and is a topic of intense political debate. Over the last forty years, the health-care system in the U.S. experienced a steady increase in both the absolute and relative amounts of spending. In 2005, the U.S. health-care budget increased 6.9%, a figure close to two times the rate of general inflation1. Total expenditures amounted to $1.99 trillion or $6700 per capita and accounted for 16% of the gross domestic product (Fig. 1)1,2. Health-care spending surpasses the national defense budget by more than threefold1,2. While the U.S. spends more on health care than any other country, it remains the only industrialized country that does not offer all citizens guaranteed health-care coverage. For comparison with other nations, the U.S. represents only one-quarter of the population of the Organization for Economic Cooperation and Development (OECD, a group of thirty developed countries), yet accounts for more than half of the total health-care expenses of this multinational group3. In 2003, the OECD countries' combined average for health-care spending as a percentage of gross domestic product was 8.6% and the group's average health-care spending per capita was $23073. That same year, the U.S. spent 15% of its gross domestic product and $5635 per capita on health care3. With so much money spent on health care, some have questioned why the U.S. life expectancy stands at 77.2 years and the infant mortality rate is seven deaths per 1000 live births while the OECD averages are 77.8 years and 6.1 deaths, respectively3. Others have questioned why so many Americans are living without health coverage or have limited access to quality health care and the effect this lack of coverage might have on heath-related statistics. Most importantly, what changes in the U.S. health-care system should be considered for moving forward?