The U.S. Health Care Delivery System: Background
The system of delivering health care in the United States is made up of many components and smaller subsystems that interact with one another. An important characteristic of the US population is its rate of growth, especially the net reproduction rate—the number of females born. The net reproduction rate is approaching one; that is, females are replacing themselves with but one daughter. Purchasers of health care continue to shift their place of residence, primarily from rural to urban and suburban areas. The moves made during the 1960-1965 period in the United States were primarily attempts to optimize their own chances in life. The migration of health providers out of the cities and into the urban fringe has left the central city with understaffed facilities and unmet health needs. Many factors preserve this pattern, including suburban realty-development cliques, bureaucratic city governments, and racial prejudices.