Services"Ambulatory care" refers to health care delivered without a stay in the hospital; most health care in the United States occurs in the outpatient setting. "Home health care services" are generally nursing enterprises, but are usually ordered by physicians. Private sector outpatient medical care is provided by personal care physicians (specialists in internal medicine, family medicine, and pediatric medicine), subspecialty physicians (gastroenterologists, cardiologists, or pediatric endocrinologists are examples) or non-physicians (including nurse practitioners and physician assistants). In 1996, concierge medicine emerged, where enhanced care and services are provided by primary care physicians for a retainer fee. FacilitiesThere are for-profit hospitals, which are usually operated by large private corporations and there are nonprofit hospitals, which may be operated by county governments, state governments, religious orders, or independent nonprofit organizations.

Hospitals provide some outpatient care in their emergency rooms and specialty clinics, but primarily they exist to provide inpatient care. Hospital emergency departments and urgent care centers are sources of sporadic problem-focused care. "Surgicenters" are examples of specialty clinics. Hospice services for the terminally ill who are expected to live six months or less are most commonly subsidized by charities and government. Prenatal, family planning, and "dysplasia" clinics are government-funded obstetric and gynecologic specialty clinics respectively, and are usually staffed by nurse practitioners. Medical products, research and developmentCompanies provide medical products such as pharmaceuticals and medical devices. The nation spends a substantial amount on medical research, mostly privately funded. As of 2000, non-profit private organizations (such as the Howard Hughes Medical Institute) funded 7%, private industry funded 57%, and the tax-funded National Institutes of Health supported 36% of medical research in the U.S.

However, by 2003, the NIH provided only 28% of medical research funding; finance from private industry increased 102% from 1994 to 2003. Research and development for applications is primarily done in commercial labs, while the government and universities fund the majority of general research.citation needed Much of this basic research is funded or conducted by governmental research institutes such as the NIH and NIMH. Health care spendingThe Office of the Actuary (OACT) of the Centers for Medicare and Medicaid Services publishes data on total health care spending in the United States. This National Health Expenditure Accounts data includes both historical spending levels and projections of future spending. Spending in 2006 totaled $2.1 trillion, or 16% of GDP. This represented an increase of 6.7% over 2004 spending. Per capita spending was $7,026. Growth in spending is projected to average 6.7% over the period 2007 through 2017. Health care spending is projected to reach 19.5 percent of GDP by 2017.

The Congressional Budget Office has found that "about half of all growth in health care spending in the past several decades was associated with changes in medical care made possible by advances in technology." Other factors included higher income levels, changes in insurance coverage, and rising prices. Hospitals and physician spending take the largest share of the health care dollar while prescription drugs take about 10 percent. The use of prescription drugs is increasing among adults who have drug coverage.

Health Care In The United States

Health care in the United States is provided by many separate legal entities. The U.S. spends more on health care, both as a proportion of gross domestic product (GDP) and on a per-capita basis, than any other nation in the world. Current estimates put U.S. health care spending at approximately 16% of GDP. The health share of GDP is expected to continue its historical upward trend, reaching 19.5 percent of GDP by 2017. In 2007, the U.S. spent a projected $2.26 trillion on health care, or $7,439 per person.According to the Institute of Medicine of the National Academy of Sciences, the U.S. is the only wealthy, industrialized nation that does not have a universal health care system. In the United States, around 84% of citizens have some form of health insurance; either through their employer (60%), purchased individually (9%), or provided by government programs (27%; there is some overlap in these figures). Certain publicly-funded health care programs help to provide for the elderly, disabled, children, veterans, and the poor, and federal law mandates public access to emergency services regardless of ability to pay.

U.S. government programs accounted for over 45% of health care expenditures, making the U.S. government the largest insurer in the nation. Per capita spending on health care by the U.S. government placed it among the top ten highest spenders among United Nations member countries in 2004.Americans without health insurance coverage at some time during 2006 totaled about 16% of the population, or 47 million people. Health insurance costs are rising faster than wages or inflation, and "medical causes" were cited by about half of bankruptcy filers in the United States in 2001.The debate about U.S. health care concerns questions of access, efficiency, and quality purchased by the high sums spent. The World Health Organization (WHO) in 2000 ranked the U.S. health care system first in both responsiveness and expenditure, but 37th in overall performance and 72nd by overall level of health (among 191 member nations included in the study). The WHO study has been criticized both for its methodology and for a lack of correlation with user satisfaction ratings.

The CIA World Factbook ranked the United States 41st in the world for lowest infant mortality rate and 45th for highest total life expectancy. A recent study found that between 1997 and 2003, preventable deaths declined more slowly in the United States than in 18 other industrialized nations. On the other hand, the National Health Interview Survey, released annually by the Centers for Disease Control's National Center for Health Statistics reported that approximately 66% of survey respondents said they were in "excellent" or "very good" health in 2006. Health care providersUnited States health care is provided by a diverse array of individuals and legal entities. Individuals are offered inpatient and outpatient services by commercial, charitable, or governmental entities. The healthcare system is not fully-publicly funded but is a mix of public and private funding. In 2004, private insurance paid for 36% of personal health expenditures, private out-of-pocket 15%, federal government 34%, state and local governments 11%, and other private funds 4%.