COVID-19 and US Health Financing: Perils and Possibilities

Int J Health Serv. 2020 Oct;50(4):396-407. doi: 10.1177/0020731420931431. Epub 2020 Jun 9.


While the COVID-19 pandemic presents every nation with challenges, the United States' underfunded public health infrastructure, fragmented medical care system, and inadequate social protections impose particular impediments to mitigating and managing the outbreak. Years of inadequate funding of the nation's federal, state, and local public health agencies, together with mismanagement by the Trump administration, hampered the early response to the epidemic. Meanwhile, barriers to care faced by uninsured and underinsured individuals in the United States could deter COVID-19 care and hamper containment efforts, and lead to adverse medical and financial outcomes for infected individuals and their families, particularly those from disadvantaged groups. While the United States has a relatively generous supply of Intensive Care Unit beds and most other health care infrastructure, such medical resources are often unevenly distributed or deployed, leaving some areas ill-prepared for a severe respiratory epidemic. These deficiencies and shortfalls have stimulated a debate about policy solutions. Recent legislation, for instance, expanded coverage for testing for COVID-19 for the uninsured and underinsured, and additional reforms have been proposed. However comprehensive health care reform - for example, via national health insurance - is needed to provide full protection to American families during the COVID-19 outbreak and in its aftermath.

Keywords: COVID-19; health care reform; health financing.

MeSH terms

  • Betacoronavirus
  • COVID-19
  • COVID-19 Testing
  • Clinical Laboratory Techniques
  • Communicable Disease Control / organization & administration
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / epidemiology*
  • Health Care Reform / organization & administration
  • Health Expenditures / statistics & numerical data*
  • Humans
  • Intensive Care Units / economics
  • Intensive Care Units / supply & distribution
  • Medically Uninsured
  • Pandemics
  • Pneumonia, Viral / epidemiology*
  • Public Health Administration / economics*
  • SARS-CoV-2
  • United States / epidemiology