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The United States is the richest country on the world and its healthcare system is the most complex of all; it is also the most expensive in relation to the percentage of the GDP and the expenditures per capita. Health expenditures in the United States duplicate the average expenses reported by other high-income countries. However, mortality related to healthcare access and quality is significantly higher in comparison to other high-income countries and some low and middle-income countries. The U.S. healthcare system is complex, with combined private and public funding, many different insurance structures, and mostly private service delivery (the latter excepting for the VA, the chronically underfunded Indian Health Service, and the insurance for the active military). It is also the most inequitable among similar countries (Geyman, 2018; Jones & Kantarjian, 2019).

In the United States, there is an unreasonable relationship between the cost of the medical services and the patients’ income, ability to pay, and health insurance situation. For instance, in 2019 there were about 30 million uninsured people. This, despite the advances made by ACA, that substantially reduced the uninsured by over 20 million. Insurance data confirm inequities: while 6.3 percent of the uninsured are non-Hispanic Whites, 10.5 percent are African Americans, 16 percent Hispanic/Latinos, 7.6 percent Asians, and about 20 percent Native Americans (Himmelstein et al., 2018).

Access barriers to healthcare are multiple and different across the nation, they go from the impossibility to obtain healthcare among the uninsured to the scarcity of health professionals (particularly in primary care) and the reduced cultural humility that the systems shows in many places to minorities and people living in poverty (Nervi, 2016). Access barriers have been proven to have a direct effect in hospitalization rates, morbidity, and mortality.