No two countries alike and so it is assumed that no two health care systems are alike. In fact, all health care systems have characteristics that make them unique to their home countries. Therefore, this report opens with a discussion of the characteristics that make the health care system of the US different from other countries. The next section has the discussion progress to external forces that affect the delivery of health care. Utilizing information about the characteristics and external factors, the impact of these are discussed in regards to the implementation of the Affordable Care Act (ACA) of 2010.
US Basic Health Care Characteristics
The US does not have a government-run, tax-financed health care system. Although commonly called a ‘system’ when in reference to different aspects, the US does not have a true health care system (Shi & Singh, 2015). One of the biggest influences to health care delivery is the government due to there being many different “government agencies involved with the financing of health care, medical and health services research, and regulatory oversight of various aspects of the health care system” (Shi & Singh, 2015). Thus, the US health care delivery system is fragmented because “no central agency governs the system” (Shi & Singh, 2015).

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One of the best ways to understand the impact of this fragmentation is through a case study that focused on Ghana, South Africa, and the United Republic of Tanzania. The three countries had a “high degree of health system fragmentation” and worked to achieve universal coverage (McIntyre et al., 2008). Fragmentation occurs due to “reliance on out-of-pocket payments [and] risk pools” since the health care system if impacted by different agencies (McIntyre et al., 2008).

Thus, the US health care system has been labeled as being expensive. In fact, it is shown that the complexity of the health care system (caused by fragmentation) lends to the high costs (Thompson, 2013). Therefore, without defragmenting the health care system through making one central agency accountable, it is expected that inefficiency will continue.

External Forces Affecting Health Care
There are also external forces that impact health care delivery. However, global influences, such as immigration, trade and travel, terrorism, and/or epidemics may have the most influence on health care delivery (Shi & Singh, 2015).

It is expected that there will be health care consequences as a result of the “current conflicts in the Middle East and Southwest Asia” (Baker, 2014). For instance, although medical advances have allowed for treatment for those obviously injured during the conflict, “there are also very high incidence rates of the hidden injuries of war” (Baker, 2014). Thus, care for these victims extends over “30 to 40 years or longer following the conflict” (Baker, 2014). This places a tremendous strain on an already fragmented health care system.

Impact of Characteristics and External Forces on the Affordable Care Act of 2010
The ACA faces different problems following its implementation. This report considers the impact of global influences and that no central agency governs the system.

No Central Agency Governs the System
Significantly, “resource allocation mechanisms must be put in place to either equalize risks between individual insurance schemes or equitably allocate general tax (and donor funds)” to achieve universal coverage (McIntyre et al., 2008). This concept has an impact on the ACA through the consideration of insurance premium payment expenses. It must be recognized, as it was in the case study, that not all citizens can afford the premium and allowances must be made for these expenses. Thus, as in the case study, the ACA must provide for “greater integration of financing mechanisms to promote universal cover with strong income and risk cross-subsidies in the overall health system” (McIntyre et al., 2008). This is one of the biggest issues that the ACA must face in order to be a success.

Global Influences
The ACA will require the entire health care system to transform. Innovation will be key in order to adapt to different situations (Davis, Abrams, & Stremikis, 2011). For instance, the ACA strengthens its financial foundation by higher reimbursement for providers. Furthermore, the ACA focuses on “innovative delivery models, such as patient-centered medical homes” (Davis et al., 2011). This can be useful for terrorism victims because access to medical help is increased. As a result, there may be fewer incidences of PTSD aggression due to early detection and treatment, as well as lower medical expenses because different conditions can be detected and treated faster.

This report focused on the US’s lack of a central agency governing the health care system and how global influences, specifically, terrorism, impacted the current health care system and the ACA. It is suggested that these two factors are linked in many ways. For instance, since there is a lack of governance, many terrorism victims are ‘slipping through the cracks’ and not receiving the care needed. However, with the implementation of the ACA, these incidences have the potential to be reduced.

  • Baker, R. M. S. (2014). Casualties of the Global War on Terror and Their Future Impact on Health Care and Society: A Looming Public Health Crisis. Military Medicine, 179(4), 348–355.
  • Davis, K., Abrams, M., & Stremikis, K. (2011). How the Affordable Care Act Will Strengthen the Nation’s Primary Care Foundation. Journal of General Internal Medicine, 26(10), 1201–1203.
  • McIntyre, D., Garshong, B., Mtei, G., Meheus, F., Thiede, M., Akazili, J., … Goudgei, J. (2008). Beyond fragmentation and towards universal coverage: insights from Ghana, South Africa and the United Republic of Tanzania. Bulletin of the World Health Organization, 86, 871–876.
  • Shi, L., & Singh, D. (2015). Delivering Health Care in America: A Systems Approach (6th ed.). Jones & Bartlett Learning.
  • Thompson, D. (2013). Why Is American Health Care So Ridiculously Expensive? Retrieved from