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date: 24 July 2017

Abstract and Keywords

This article examines the five forms of payment for healthcare that are common in the United States: out-of-pocket, charity, direct public provision, public health insurance, and private health insurance (including employer-sponsored insurance). After discussing the history of each of the five approaches, the article considers their advantages and disadvantages as well as their current status. It examines next the 2010 Affordable Care Act. Although the Affordable Care Act focuses primarily on expanding public health insurance and public financing for private health insurance, it incorporates all five approaches to financing care. Finally this chapter considers why the United States retains this patchwork of different forms of coverage rather than adopting a single coherent system of health care finance and discusses the likely future of the American approach.

Keywords: healthcare, government-sponsored healthcare, United States, out-of-pocket payment, charity, direct public provision, public health insurance, private health insurance, employer-sponsored insurance, Affordable Care Act

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