Transportation and Health Care Access

Health care services are paid for through a mix of public and private, for-profit and nonprofit insurers and health care providers. On the public side, the Medicare program covers costs for adults age 65 and older and some people with disabilities, veterans and low-income people. Medicaid, a safety net program funded jointly by the federal government and states, covers costs for those who meet low-income levels. Medicaid programs are managed directly by each state under the oversight of the Centers for Medicare and Medicaid Services (CMS). States determine who and what type of services will be covered in their programs; as such, one person whose income is at 200% of the U.S. poverty level may be eligible in one state but not in another. Private insurance, the dominant form of coverage, is provided primarily by employers.

The United States spends more on health care services than does any other developed nation; the main drivers of these costs are estimated as 33% for hospital care, 25% for professional office-based services, 13% for long-term care, and 9% for prescription drugs. Two factors in the cost of health care are frequency of usage and the fee-per-service form of reimbursement. Looking at frequency, a small proportion of the health care-seeking population—approximately 5% in one study–accounts for the majority of health expenditures.