Planning your elective: the United States

The United States needs little introduction. It is big, expensive, and alleged to be one of the best--although it comes a rather low 37th in the World Health Organisation's ranking of health systems. It is widely quoted that although Americans spend 11% of their gross domestic product on health care, 30 million people cannot afford fees or insurance producing a huge disparity between the rich and poor. There are four sources of health funding:

• Patient fees

• Private insurance

  Federal funded Medicare insurance for elderly and disabled people

• State funded Medicare insurance for families on low incomes

As stated in this month's elective report, there are often wrangles between what is best for the patient and what insurance companies are willing to pay for. In my …