Organisation of the Health System
The United States' health system is actually a cluster of health systems of diverse complexity. Federal, state, and local governments have defined, often in concert with one another, their roles in protecting the public's health. State public health departments are not under the jurisdiction of federal health agencies and administrations, and, in many states, city and county local public health departments are not under the jurisdiction of state public health departments. As a rule, direct healthcare services are provided by the private sector. Many of these governmental and nongovernmental services share public funds, technical advice, regulatory standards, and health research provided by federal, state, and local governments.
The federal government manages various programmes; oversees research; and provides technical advice and direction, training, funding, and other public health resources, mainly through the Department of Health and Human Services. The Department often works through state and local government programmes and with other partners. Responsibility for individual healthcare issues is much more decentralised. The government provides health insurance to highly vulnerable groups, such as some families in poverty, the disabled, and the elderly. Most persons, however, acquire private health insurance coverage through their employers or on their own. Direct healthcare services, including primary, secondary, and tertiary care, are provided primarily by thousands of private sector hospitals and clinics throughout the country. The federal government directly funds additional hospitals and clinics that care for military personnel and veterans and for American Indians and Alaskan Natives.
In 2005, the U.S. Department of Health and Human Services spent more than 30 billion US dollars on research, demonstration, and evaluation, including investments for medical research, public health, and food and drug safety. The National Institutes of Health invests more than US$ 27 billion annually in medical research, 80% of which is awarded through almost 50,000 competitive grants to more than 212,000 researchers at more than 2,800 universities, medical schools, and other research institutions in every state and around the world. Another 10% of the Institutes' budget supports projects conducted in its own laboratories by nearly 6,000 scientists.
Within the Department of Health and Human Services, the Centers for Disease Control and Prevention (CDC) spends more than 650 million US dollars on research to meet health and safety challenges, including public health research on emerging infectious diseases, environmental threats, the aging population, and lifestyle choices. Another Department component, the Food and Drug Administration (FDA), conducts research and carries out regulatory activities to ensure the safety of food, drugs, devices, and cosmetics. FDA spends over 140 million US dollars on research.
Other major areas of research within the Department of Health and Human Services include healthcare quality, aging, and mental health services.
In 2004, there were more than 17 million jobs in the health sector or in health occupations outside the health sector, accounting for nearly 12% of the total U.S. workforce. Among these were approximately 2.4 million registered nurses, 1.45 million nursing aides, 1.3 million personal care or home health aides, 567,000 physicians, 230,000 pharmacists, and 150,000 dentists.
Noting that healthcare is the fastest growing employment sector in the country, the U.S. Bureau of Labour Statistics projected that between 2004 and 2014, the healthcare sector will grow by more than 27%, compared to a growth under 12% for all other employment sectors. Within healthcare, jobs in home healthcare and offices of health practitioners, particularly physician offices, are projected to grow the fastest. The health occupations projected to add the most new jobs over the 10-year period are registered nurses (703,000 new jobs), home health aides (350,000 new jobs), and nursing aides (325,000 new jobs). More than 200,000 physicians and 100,000 new pharmacists will also be needed to fill new jobs as well as replace those who leave existing positions. Most sources acknowledge a serious nursing shortage, which may become more severe as the population continues to age. Reimbursement issues, working conditions, and regulatory requirements are cited as contributing factors.