<P> One innovation in encouraging quality of health care is the public reporting of the performance of hospitals, health professionals or providers, and healthcare organizations . However, there is "no consistent evidence that the public release of performance data changes consumer behaviour or improves care ." </P> <P> The US health care delivery system unevenly provides medical care of varying quality to its population . In a highly effective health care system, individuals would receive reliable care that meets their needs and is based on the best scientific knowledge available . In order to monitor and evaluate system effectiveness, researchers and policy makers track system measures and trends over time . The US Department of Health and Human Services (HHS) populates a publicly available dashboard called, the Health System Measurement Project (healthmeasures.aspe.hhs.gov), to ensure a robust monitoring system . The dashboard captures the access, quality and cost of care; overall population health; and health system dynamics (e.g., workforce, innovation, health information technology). Included measures align with other system performance measuring activities including the HHS Strategic Plan, the Government Performance and Results Act, Healthy People 2020, and the National Strategies for Quality and Prevention . </P> <P> The US health system does not provide health care to the country's entire population . Individuals acquire health insurance to offset health care spending . However, lack of adequate health insurance persists and is a known barrier to accessing the healthcare system and receiving appropriate and timely care . Measures of accessibility and affordability tracked by national health surveys include: having a usual source of medical care, visiting the dentist yearly, rates of preventable hospitalizations, reported difficulty seeing a specialist, delaying care due to cost, and rates of health insurance coverage . </P> <Ul> <Li> As a country, rising health care costs have raised concerns among the public and private sector alike . Between 2000 and 2011, health care expenditures nearly doubled, growing from $1.2 trillion to $2.3 trillion (CDC Health, United States, 2013). Evidence suggests the rate of growth has slowed in recent years . Other measures of cost captured by national surveys include: health insurance premiums, high out of pocket costs (e.g., deductibles, copayments), and national health expenditures including individual, employer, and government expenditures . </Li> </Ul>

16. what institutions make up the u.s. healthcare system