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Market based health systems

The United States: Diabetes Prevention Program
The US is the only developed economy where the private sector plays the dominant role in
healthcare financing and delivery, which largely makes it the most expensive and inequitable
health-care system in the world. However, in terms of chronic disease lifestyle intervention,
as exemplified by the Diabetes Prevention Program (DPP), the US has one of the earliest DPP
which greatly contributes to the evidence and implementation of the DPP worldwide. After
further development in the two decades since the programme was first launched in 2002,
DPP in the US has been adapted for delivery in community settings using a lower-cost,
group based lifestyle intervention in which participants have achieved significant reductions
in weight, although usually less than those observed in the original DPP (Alva et al., 2017; Ely
et al., 2017; Mudaliar et al., 2016). The DPP has been adapted to specific racial and ethnic
groups who are more likely to be in need of treatment due to inequality in socioeconomic
factors as well as in healthcare financing.

Table 2.4
The United States’ market-based health system

Country Key Features of Health Strategic Purchasing Policies & Frameworks
Financing System

The United How is the healthcare Lifestyle intervention programmes in the United States,
States system financed? like Diabetes Prevention Program (DPP), with intensive
lifestyle intervention or pharmacotherapy have been
Financed significantly widely adapted to specific racial and ethnic groups and
through private health implemented in varied settings.
insurance and public
entitlements The expansion of Medicaid under the 2010 Affordable
Care Act (ACA), laying a foundation for initiatives like
Multipayer system (public the Million Hearts Campaign and the Medicaid
and private insurance + Incentives for Prevention of Chronic Diseases
for-profit and nonprofit (MIPCD) grant program.
insurers and providers)
• Who is the purchaser?
Insurance is voluntary; Medicaid insurers
Premiums are paid by the
individual and/or employer. • What to purchase?
Social insurance Behavioural interventions, such as tobacco cessation
mechanisms: and weight management, for prevention or better
control of hypertension, lipid disorders, and diabetes.
Medicare: payroll tax shared
by employees and • From whom to purchase?
employers; premiums; YMCA or other community facilities
federal general tax revenue.
Medicaid: Federal and state • How to purchase?
taxes.
Fee-for-service or value-based payment.
Individual, employee, group,
or family purchase private
company insurance.

CHIP: Children’s Health
Insurance Program for
children in low income
families.

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