The US life expectancy is 78.6 years at birth, up from 75.2 years in 1990 this ranks 42nd among 224 nations, and 22nd out of the 35 industrialized OECD countries, down from 20th in 1990. Managed care, where payers use various techniques intended to improve quality and limit cost, has become ubiquitous. Health insurance for public sector employees is primarily provided by the government in its role as employer. People aged under 65 acquire insurance via their or a family member's employer, by purchasing health insurance on their own, getting government and/or other assistance based on income or another condition, or are uninsured. In 2013, 64% of health spending was paid for by the government, and funded via programs such as Medicare, Medicaid, the Children's Health Insurance Program, Tricare, and the Veterans Health Administration. Healthcare coverage is provided through a combination of private health insurance and public health coverage (e.g., Medicare, Medicaid). According to the World Health Organization (WHO), the US spent $9,403 (equivalent to $10,738 in 2021 ) on healthcare per capita, and 17.9% on healthcare as percentage of its GDP in 2014. 58% of community hospitals in the US are nonprofit, 21% are government-owned, and 21% are for-profit. Healthcare facilities are largely owned and operated by private sector businesses. Healthcare is provided by many distinct organizations, made up of insurance companies, healthcare providers, hospital systems, and independent providers. The US is the only developed nation without a system of universal healthcare, with a large proportion of its population not carrying health insurance, a substantial factor in the country's excess mortality. Despite this, the country has significantly worse healthcare outcomes when compared to peer nations. Healthcare in the United States is far outspent than any other nation, measured both in per capita spending and as a percentage of GDP.
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