Adding to the size of the market is the fact that per capita expenditure, at US$399, is the highest in the world.
Much of the market is in private hands; there is no single health system. Public healthcare systems, known as Medicaid, for those on low incomes, are operated by each State. Since 1960, the Medicare system has provided hospital care for the elderly; this has also provided prescription drug coverage since 2006.
President Obama succeeded in signing his healthcare reform bill into law on March 23, 2010. The bill, formally called the Patient Protection and Affordable Care Act (PPACA) HR 3590, will eventually extend health insurance cover to an estimated 32mn Americans who do not have any form of health insurance.
The PPACA requires all States to create new health insurance markets called exchanges, so that people who do not have insurance can buy tax-payer subsidised private cover. The law also expands eligibility for Medicaid so low-income adults who have no dependent children can get government insurance. Putting the two approaches together, more than 30mn Americans are expected to gain coverage by Jan. 2014. At the end of June 2012, the Supreme Court upheld the entire law in a 5-to-4 decision, which deemed that the mandate was constitutional under the taxing authority afforded to the federal government.
The USA is home to many of the world's leading medical device manufacturers, such as Johnson & Johnson, General Electric, Baxter, Covidien, and Medtronic. Seven out of the world's top ten medical device manufacturers are U.S. companies.