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The key players in the system are the physicians, administrators of health service institutions, insurance executives, large employers, and the government. One positive effect of these opposing forces is that they prevent any single entity from dominating the system.
There are four basic designs healthcare systems follow: the Beveridge model, the Bismarck model, the national health insurance model, and the out-of-pocket model. The U.S. uses all four of these models for different segments of its residents and citizens.
Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments.
Introducing the Key Stakeholders: Patients, Providers, Payors, and Policymakers (the Four Ps) Connecting Health Information Systems for Better Health.
Currently, the top five payers in the market are: UnitedHealth Group (49.5 million members) Anthem (40.2 million members) Aetna (merged with CVS; 22.2 million members) Cigna (15.9 million members) Humana (14 million members)
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As illustrated in Figure 11, a health care de- livery system incorporates four functional componentsfinancing, insurance, delivery, and payment thatthat are necessary for the delivery of health services.

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