Health System Reform in the United States

Document Type : Perspective


Department of Health Policy and Management, Harvard School of Public Health, Harvard University, USA


In 2010, the United States adopted its first-ever comprehensive set of health system reforms in the Affordable Care Act (ACA). Implementation of the law, though politically contentious and controversial, has now reached a stage where reversal of most elements of the law is no longer feasible. The controversial portions of the law that expand affordable health insurance coverage to most U.S. citizens and legal residents do not offer any important lessons for the global community. The portions of the law seeking to improve the quality, effectiveness, and efficiency of medical care as delivered in the U.S., hold lessons for the global community as all nations struggle to gain greater value from the societal resources they invest in medical care for their peoples. Health reform is an ongoing process of planning, legislating, implementing, and evaluating system changes. The U.S. set of delivery system reforms has much for reformers around the globe to assess and consider.


Main Subjects


    1. Frenk J. The global health system: strengthening national health systems as the next step for global progress. PLoS Med 2010; 7: e1000089. doi: 10.1371/journal.pmed.1000089  
    2. Dentzer S. The Triple Aim Goes Global. Health Aff (Millwood) 2013; 32: 638. doi: 10.1377/hlthaff.2013.0274
    3. Institute of Medicine. Crossing the Quality Chasm [internet]. 2001. Available from: Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx. doi: 10.1177/152715440100200312
    4. Institute of Medicine. Coverage Matters: Insurance and Health Care. Washington, DC: National Academies Press; 2001.
    5. McDonough J, Rosman B, Phelps F, Shannon M. The Third Wave of Massachusetts Health Care Access Reform. Health Aff (Millwood) 2006; 25: W42–431. doi: 10.1377/hlthaff.25.w420
    6. Affordable Care Act [internet]. Available from: healthcare/rights/law/
    7. McDonough J. Inside National Health Reform. Berkely, California: University of California Press and the Milbank Fund; 2011. doi: 10.1002/wmh3.7  
    8. U.S. Surgeon General. National Prevention Strategy [internet]. Available from: strategy/
    9. McDonough J. The Road Ahead for the Affordable Care Act. N Engl J Med 2012; 367: 199–201. doi: 10.1056/nejmp1206845
    10. Commonwealth Fund. International Health Policy Center [internet]. Available from: Health-Policy.aspx