This article was originally published on Globe.com as part of our collaboration with Boston Globe Media.

The US health care system has a reputation for being complex — and for good reason. It is designed to serve more than 340 million people through a mix of public programs, private insurance, and a vast network of health care providers. A clearer understanding of how the system works can help individuals navigate insurance, choose providers, and advocate for their needs.

That understanding is one important part of health literacy, the ability to find, interpret, and use health information and services. Higher levels of health literacy are linked to better health outcomes, greater well-being, more effective use of health services, and reduced health inequities, according to research. Improving health literacy is a central focus of the US Department of Health and Human Services' Healthy People 2030 objectives. 

System overview

At its core, the US health care system exists to treat illness and injury. Treatment is provided  across settings, from routine primary care visits and preventive screenings to hospital stays, specialty treatment, and long-term support. 

Unlike countries with a single national health program, the United States relies on a mixed system to deliver care and help cover its cost. Government insurance programs such as Medicare and Medicaid typically partner with private insurance, and for most people who are employed, their benefits are tied to their employer who partners with a health plan.  Regardless of whether coverage is employer or government sponsored, people receive their care delivered by a wide range of not-for-profit and for-profit providers. There is no single point of entry; people move through the system in different ways depending on their needs, coverage, and circumstances.

Four groups play distinct and important roles within the health care system:

Patients:

Patients are the reason the health care system exists. They are the recipients of care, and increasingly, active participants in decisions about their health. Today, patients choose care providers, track symptoms, manage chronic conditions, and weigh treatment options, often working in partnership with providers to align care with their health goals. 

Research shows patients who take part in decision-making about their health tend to report higher levels of satisfaction with their care and are more likely to adhere to screening, diagnostic, or treatment plans. In some cases, patient engagement is also linked to improved health outcomes. 

Advancing technology has played a role in increased patient engagement, from patients using wearables to collect health data to online portals to find information or communicate with providers. The share of patients who have accessed their online medical records or patient portal has more than doubled from 25 percent in 2014 to 65 percent in 2024.

Providers:

Providers are the people and organizations that deliver health care. This group includes doctors, nurses, physician assistants, therapists, and pharmacists, as well as the hospitals, clinics, urgent care centers, and community health organizations where they work. Understanding how different providers work together can help patients know where to turn when, what questions to ask, and how to move through the system more efficiently.

Primary care providers (PCPs) often serve as the front door to the health care system, handling preventive care, routine visits, and ongoing health management. When more specialized care is needed, PCPs often help coordinate referrals and next steps so patients can see specialists for diagnostic testing or treatment. Urgent care and other outpatient centers provide timely treatment for non-emergency issues and procedures that don’t require a hospital stay, such as minor injuries and infections, while hospitals provide acute and emergency care. Post-acute, home-based and community providers support recovery, rehabilitation, and long-term care.  

The US health care system relies on a large provider workforce, with more than 1 million active physicians and over 4.5 million registered nurses practicing at thousands of hospitals and outpatient facilities nationwide.

Payers:

Payers are organizations that help cover or reimburse the cost of health care services. This includes private health plans as well as public programs such as Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Together, they finance care for most people in the United States: As of 2022, about 92 percent of US citizens had health coverage, through a mix of employer-sponsored plans (48.7 percent), individual coverage (6.3 percent), and public insurance (35.8 percent). 

Private insurance remains the most common source of coverage for people who are employed. For people without employer-sponsored insurance, coverage is available through health insurance marketplaces, where individuals and families can compare plans and may qualify for financial assistance based on income. 

Public programs play a critical role as a safety net in the system. Medicare serves adults age 65 and older, as well as some younger people with long-term disabilities. Medicaid, jointly funded by federal and state governments, provides coverage for individuals and families with lower incomes, and CHIP helps insure children who are not eligible for Medicaid but lack access to private coverage. 

Beyond processing claims, health plans help members understand their benefits, connect with trusted providers, and access preventive and ongoing care.

Regulators:

Regulators are federal and state agencies responsible for overseeing how health care is delivered and paid for. Their responsibilities include setting standards for safety and quality, protecting patient rights, and ensuring access to care across different populations and regions. 

Organizations such as the Centers for Medicare & Medicaid Services, state departments of public health, and insurance regulators play a largely behind-the-scenes role that many patients never encounter directly. Their oversight influences everything from hospital safety requirements and provider standards to insurance rules and public health initiatives. 

In 2024, the Massachusetts Department of Public Health issued and maintained more than 443,500 licenses, registrations, and permits for health care professionals. The department also conducted inspections to ensure health care facilities met state safety and quality standards, helping keep millions of patients and seniors safe.

Regulators create guardrails that help a complex system function. By setting expectations and enforcing accountability, regulators support consistency, reliability, and trust — not just for individual patients, but for the health care system as a whole.

Why understanding the system matters

Health care touches nearly every stage of life, from routine checkups and preventive care to moments when decisions carry real urgency. When the system feels hard to navigate, people may delay care, miss preventive services, or feel unsure about where to turn.

Understanding can change that. Knowing how care is organized helps individuals take a more active role in their health and make choices that fit their needs. 

Those benefits extend beyond the individual. Research on health literacy interventions shows that strengthening health literacy improves coordination across health care, public health, and community organizations, helping close gaps in access at the community level. 

A clearer understanding of how health care works isn’t just empowering — it’s a pathway to better health and access for individuals and communities.