Many Americans rely on emergency departments for acute, chronic, and even preventive care ( Institute of Medicine, 2007a Schoen et al., 2009b, 2011). The United States has a relatively weak foundation for primary care and a shortage of family physicians ( American Academy of Family Physicians, 2009 Grumbach et al., 2009 Macinko et al., 2007 Sandy et al., 2009). Access to health care services, particularly in rural and frontier communities or disadvantaged urban centers, is often limited. population) were uninsured ( DeNavas-Walt et al., 2011). In 2010, 50 million people (16 percent of the U.S. The United States stands out from many other countries in not offering universal health insurance coverage. Higher mortality rates from diseases, and even from transportation-related injuries and homicides, may be traceable in part to failings in the health care system.
Although the United States is renowned for its leadership in biomedical research, its cutting-edge medical technology, and its hospitals and specialists, problems with ensuring Americans’ access to the system and providing quality care have been a long-standing concern of policy makers and the public ( Berwick et al., 2008 Brook, 2011b Fineberg, 2012).
One explanation for the health disadvantage of the United States relative to other high-income countries might be deficiencies in health services.
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