tion actually receiving one is not exceptionally high (see Table 7-1). On the age-standardized death rate above age 50 from influenza, the United States ranks sixth among 16 OECD countries (Preston and Ho, 2010). The proportion of individuals having their blood pressure checked in the past year is higher in the United States than in four other English-speaking countries (Schoen et al., 2004, Exhibit 6). In this study, however, U.S. physicians were less likely to send out reminders for preventive care than physicians in the other countries (Schoen et al., 2004, Exhibit 6). Eighty percent of Americans have a physician they see regularly, a lower percentage than that in six other OECD countries (Schoen et al., 2007). On screening for major cancers, a form of preventive medicine, the United States ranks first among OECD countries (Howard et al., 2009).

Efforts to identify early stages of a disease—for example, through screening—are sometimes termed “secondary prevention” and are a principal responsibility of the health care system. One could take a broader view of the responsibilities of the health care system and include among them the prevention of harmful personal behaviors such as smoking, lack of exercise, and excess calorie consumption (Murray and Frenk, 2010), sometimes termed “primary prevention.” From this vantage point, as noted in previous chapters, the U.S. health care system performs poorly. This report addresses these behaviors individually, however, and this chapter focuses more narrowly on the health care system—the array of hospitals, physicians, and other health care professionals; the techniques they employ; and the institutions that govern access to and utilization of these resources. Efforts to identify early stages of a disease, for example, through screening, is sometimes called “secondary prevention” and is a principal responsibility of the medical system.

ACCESS TO HEALTH CARE

Access to health care in the United States is limited by the availability of health insurance, with 16.7 percent of the resident population lacking coverage (DeNavas-Walt et al., 2010). The young—both adults and children—are most likely to lack health insurance. Only 10 percent of the uninsured are aged 55 or older; only 2 percent of those 65 and over are uninsured, compared with 13 percent of those 55–64.

Data from the National Health and Nutrition Examination Survey (NHANES), 2003–2006, for those aged 55–64 reveal that uninsured and insured adults do not differ significantly in the prevalence of many health conditions and risk factors. The two groups are similar in levels of ever having had cancer (uninsured 10.2 percent, insured 10.5 percent) or a heart attack (4.7 and 4.6 percent), although the insured report a somewhat higher prevalence of stroke (1.9 versus 3.2 percent), diabetes (10.2 versus



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