health service

The structure of the English National Health Service. The NHS trusts date from changes made in 1990, while the primary care groups were formed in 1999, by the reorganization of GPs' practices.

Government provision of medical care on a national scale.

State and local governments provide some public health services. The USA provides care through private physicians and hospitals who are paid by the federally subsidized schemes Medicare and Medicaid. The Medicare health-insurance plan provides outpatient care for the elderly and disabled (toward which patients pay a share), and since 1985, fees for Medicare patients to join health-maintenance organizations (HMOs, covering visits to a group of doctors and hospital fees). The Medicaid state plan is paid to the state by the federal government for people unable to afford private care. US private health schemes include Blue Cross (established in 1929) and Blue Shield (established in 1917), as well as other insurance companies' plans.

A survey released in October 1999 by the US Census Bureau revealed that more Americans are going without private health insurance. The study found that about 44.3 million people had no coverage in 1998, about a million more than in 1997. Because of population increase, however, the percentage only increased from 16.1% in 1997 to 16.3% in 1998.