Abstract

This article's objectives are to describe the health care reform process during the 90's in the United States of America and to analyze its consequences for health system performance.We performed a literature search on US health care reform during the 90's. The methodology of analysis was taken from Evans, who developed an approach that integretes the dimensions of organization and management, financing and, attention and provision.We verified that the US health care system continued to be based upon individualism and competition, combining actions of public protection for specific social groups with the production of services by the market. The market’s logic has not prevented growing state intervention through regulation. Competition generated many innovations in financial management, which improved efficiency at the micro level. Nevertheless, the increase of total health care expenditures as a percentage of GDP and the existence of a significant part of the population without coverage, highlight the inefficiency of the system at the macro level.