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Disparities and the American Health Care System

Amin, Sheena A., BS*; McEntee, Richard M., BS; Wagner, Scott C., MD; Schroeder, Gregory D., MD; Knightly, John J., MD§; Vaccaro, Alexander R., MD, PhD, MBA

doi: 10.1097/BSD.0000000000000608

The United States’ health care system is often compared with those of other industrialized countries, and consistently ranks poorly in terms of health care delivery, efficiency, and quality. However, there are several considerations unique to the United States that are often distorted in these analyses, and when considered in the context of the convoluted ethnic and social disparities that persist in the United States, the successes of the American health care system become more apparent.

*Drexel University College of Medicine

Sidney Kimmel School of Medicine, Thomas Jefferson University

Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA

§Atlantic Neurosciences Institute, Summit, NJ

The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of Navy, Department of the Army, Department of Defense, or US Government. One author is employee of the United States government.

Dr Schroeder has received funds to travel from AO Spine and Medtronic. Dr Vaccaro has consulted or has done independent contracting for DePuy, Medtronic, Stryker Spine, Globus, Stout Medical, Gerson Lehrman Group, Guidepoint Global, Medacorp, Innovative Surgical Design, Orthobullets, Ellipse, and Vertex. He has also served on the scientific advisory board/board of directors/committees for Flagship Surgical, AO Spine, Innovative Surgical Design, and Association of Collaborative Spine Research. Dr Vaccaro has received royalty payments from Medtronic, Stryker Spine, Globus, Aesculap, Thieme, Jaypee, Elsevier, and Taylor Francis/Hodder and Stoughton. He has stock/stock option ownership interests in Replication Medica, Globus, Paradigm Spine, Stout Medical, Progressive Spinal Technologies, Advanced Spinal Intellectual Properties, Spine Medica, Computational Biodynamics, Spinology, In Vivo, Flagship Surgical, Cytonics, Bonovo Orthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I., Rothman Institute and Related Properties, Innovative Surgical Design, and Avaz Surgical. He has also served as deputy editor/editor of Spine. In addition, Dr Vaccaro has also provided expert testimony. The remaining authors declare no conflict of interest.

Reprints: Scott C. Wagner, MD, Rothman Institute, Thomas Jefferson University Hospitals, Philadelphia, PA 19107 (e-mail:

Received August 17, 2017

Accepted November 29, 2017

© 2019 by Lippincott Williams & Wilkins, Inc.