INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)  
ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue XI November 2025  
Healthcare in America: Innovation, Access, and the Human Cost  
Oluchi Jane Maduka., Ashley Timean., Mohiramo Bahronbekova., Edgitha Eyra Amuzu  
Carolina University  
DOI: https://dx.doi.org/10.47772/IJRISS.2025.91100392  
Received: 30 November 2025; Accepted: 02 December 2025; Published: 11 December 2025  
ABSTRACT  
The United States healthcare system presents a paradox in which world-class medical innovation coexists with  
persistent disparities in access, affordability, and population health outcomes. Although the United States leads  
globally in pharmaceutical development, medical device manufacturing, and genomic and digital health  
innovations, millions of Americans continue to face barriers to essential care due to cost, insurance status, or  
geographic inequities. According to recent national expenditure data, healthcare spending reached approximately  
$4.9 trillion in 2023, equivalent to $14,570 per person and 17.6% of GDP. Despite this investment, an estimated  
26 million individuals remained uninsured for some or all of 2023. This study uses a cross-sectional, quantitative  
approach and publicly available datasets from the Centers for Medicare & Medicaid Services, the U.S. Census  
Bureau, and the Centers for Disease Control and Prevention to examine relationships among innovation-driven  
spending, insurance coverage, affordability, and health outcomes. Findings highlight that while innovation  
spending correlates with improved clinical performance in several domains, its benefits remain uneven due to  
persistent affordability barriers. Recent evidence also shows that avoidable mortality has increased in all U.S.  
states over the past decade despite rising spending. The paper concludes with policy and organizational  
recommendations that emphasize aligning innovation and financing with equity-driven reforms in coverage,  
affordability, and organizational decision-making.  
Keywords: Healthcare innovation; Access and affordability; Equity; U.S. healthcare; Quantitative analysis;  
Policy reform.  
INTRODUCTION  
The United States healthcare system stands out globally for its rapid technological advancement, pioneering  
biomedical research, and highly specialized clinical procedures. However, at the same time, it remains one of  
the most inequitable healthcare environments among industrialized nations, with coverage gaps affecting  
millions of adults and children (U.S. Census Bureau, n.d.). Recent national reporting indicates that although 92%  
of Americans had health insurance for some or all of 2023, approximately 26 million remained uninsured for  
part or all of the year (U.S. Census Bureau, 2024). These figures highlight a fundamental contradiction: the U.S.  
maintains a highly innovative and technologically sophisticated healthcare system, yet many individuals struggle  
to access basic preventive, primary, and specialty care. Although implemented policies, such as the Patient  
Protection and Affordable Care Act (ACA), significantly reduced the uninsured rate from 14.4% in 2013 to a  
historic low of 7.7%, the American population remains uninsured due to factors like employer-sponsored  
coverage limitations (Office of the Assistant Secretary for Planning and Evaluation, 2024; Tolbert et al., 2024).  
In 2023, 64.7% of uninsured workers were employed by firms that offered no health benefits. For the nearly 50  
million individuals working in the nation’s 3.2 million small businesses, rising dependent premium costs have  
made family coverage largely unaffordable (Tolbert et al., 2024). This duality raises a fundamental question:  
How can a healthcare system capable of extraordinary scientific breakthroughs fail to guarantee universal access  
to basic medical care?  
National expenditure trends reinforce this tension. In 2023, U.S. healthcare spending reached approximately $4.9  
trillion, representing $14,570 per person and 17.6% of the country’s gross domestic product (Centers for  
Medicare & Medicaid Services, 2025). Despite this unprecedented level of investment, significant population  
indicators, including health indicators such as life expectancy and avoidable mortality, continue to underperform  
relative to peer nations. Empirical work on avoidable mortality shows that preventable and treatable premature  
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deaths have increased across all U.S. states over the past decade, while declining in many comparable countries  
(Papanicolas et al., 2025). Such findings raise critical questions about the structural functioning of the U.S.  
healthcare system and suggest that innovation alone cannot offset deeply rooted disparities in access and  
affordability. To understand this paradox, it is essential to view healthcare not only as a clinical sector but also  
as an economic and organizational system that shapes and is shaped by policies, market pressures, and  
population-level inequities (Mick & Shay, 2014). Understanding these dynamics requires an integrated  
perspective combining innovation theory, equity frameworks, and organizational systems thinking.  
Given this context, this article examines the convergence of innovation, cost-effectiveness, and access to  
healthcare through a quantitative lens. By analyzing national trends in expenditures, insurance availability, and  
health outcomes, the research assesses whether heightened innovation significantly enhances public health or  
whether systemic disparities diminish its effects. The assessment is based on Innovation Diffusion Theory,  
Equity Theory, and Organizational Systems Theory, offering a comprehensive framework for comprehending  
how technological progress disseminates, how it affects equity in resource allocation, and how organizational  
choices influence the broader healthcare landscape. Using this unified perspective, the article seeks to highlight  
the human and financial impacts of an innovative, focused system that fails to universally ensure fair access to  
healthcare, while also pinpointing policy and organizational changes that could close this ongoing divide.  
LITERATURE REVIEW  
Healthcare Spending Trends in the United States  
Healthcare spending in the United States has continued to rise sharply relative to economic growth. National  
expenditure data show that spending reached approximately $4.9 trillion in 2023, reflecting a 7.5% annual  
increase and amounting to 17.6% of GDP (Centers for Medicare & Medicaid Services, 2025). This escalation  
has been driven by expanding utilization of hospital care, physician services, and high-cost prescription drugs  
(U.S. Census Bureau, 2024). While these investments are often justified as necessary for advancing clinical  
innovation, they also contribute to rising premiums and overall system costs for organizations and consumers.  
As a result, spending growth has outpaced wage growth and broader economic performance, creating structural  
strains across the system (Centers for Medicare & Medicaid Services, 2025).  
Coverage and Access Patterns  
The Affordable Care Act produced historic reductions in the uninsured population, but coverage gaps remain.  
Census Bureau data show that 92% of Americans held health insurance at some point in 2023, yet approximately  
26 million people remained uninsured for part or all of the year (U.S. Census Bureau, 2024). Coverage inequities  
persist sharply across states, particularly between Medicaid-expansion and non-expansion states (Centers for  
Medicare & Medicaid Services, 2025). Moreover, the uninsured rate remained disproportionately higher among  
low-income households, racial and ethnic minority groups, and individuals in unstable employment  
arrangements (U.S. Census Bureau, 2024). These patterns illustrate that the availability of advanced medical  
innovation does not ensure adequate or equitable access to care.  
Affordability and Cost Burdens  
Affordability challenges extend beyond coverage status. Even among insured individuals, high deductibles,  
copayments, and premium contributions increasingly delay or prevent needed care (Kaiser Family Foundation,  
2024). Rising insurance costs also directly affect small and medium-sized enterprises (SMEs), as recent trends  
show that workers in small firms face higher premiums and cost burdens than those in large firms  
(Commonwealth Fund, 2024). Employers with lower revenue levels are disproportionately burdened by  
healthcare costs, with firms earning under $600,000 annually allocating a significantly higher percentage of  
payroll to health benefits than larger firms (JPMorgan Chase Institute, 2024). These financial pressures limit  
benefit generosity and shift more costs onto workers, reinforcing socioeconomic disparities in real access to  
healthcare.  
Health Outcomes and Avoidable Mortality  
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Despite world-leading investment in healthcare and innovation, primary health outcomes in the United States  
continue to lag behind those in comparable nations (Schneider et al., 2024). A multi-country analysis found that  
avoidable mortality increased in every U.S. state between 2009 and 2019, while declining across most other  
high-income countries (Papanicolas et al., 2025). This trend suggests persistent failures in prevention and timely  
treatment, reflecting weaknesses in public health infrastructure, primary care access, and early disease detection  
(Tikkanen & Abrams, 2020). Furthermore, the study established that although greater spending correlates with  
lower avoidable mortality internationally, this relationship is weak or non-existent within U.S. states  
(Papanicolas et al., 2025). Additional comparative research shows that the U.S. spends significantly more per  
capita than its peers yet perform worse on preventable mortality, indicating structural inefficiencies and regional  
disparities (OECD, 2023). These findings challenge the assumption that higher investment alone leads to  
improved outcomes and emphasize the role of equity, access, and affordability in shaping national performance  
(Schneider et al., 2024).  
Theoretical Foundation  
This study integrates three complementary theoretical frameworks to explain how healthcare innovation, access,  
and system equity interact within the United States healthcare environment: Innovation Diffusion Theory, Equity  
Theory, and Organizational Systems Theory. Together, these frameworks provide a conceptual foundation for  
analyzing the relationships among healthcare spending, insurance coverage, affordability, and population health  
outcomes.  
Innovation Diffusion Theory (Rogers, 2003)  
Innovation Diffusion Theory, developed by Rogers (2003), offers a key perspective for understanding how new  
technologies and practices spread through social systems. In the U.S. healthcare system, the diffusion process  
often occurs unevenly, with cutting-edge innovations initially adopted by high-resource academic medical  
centers, large integrated delivery networks, and technologically advanced hospitals. Innovations like robotic  
surgery, genomic sequencing, AI-assisted diagnostics, and telehealth platforms typically enter the market  
through institutions with more financial and human resources. Lower-resource facilities, including community  
hospitals, rural clinics, and safety-net providers, adopt these technologies more slowly because of financial,  
infrastructural, and staffing challenges.  
This uneven diffusion pattern explains why increased national investment in innovation does not automatically  
lead to widespread improvements in population health. When the benefits of innovation are limited to those with  
stable insurance coverage and reliable access to advanced healthcare systems, disparities in outcomes grow wider  
instead of shrinking. In this study, Innovation Diffusion Theory helps clarify how technological progress can  
improve clinical performance but may not result in equitable gains at the population level.  
Equity Theory (Adams, 1965)  
Equity Theory frames healthcare access as an issue of fairness. It interprets disparities in insurance coverage,  
service utilization, and preventive care as outcomes of inequitable resource distribution. Equity Theory, initially  
developed by Adams (1965), frames fairness not only in terms of outcomes, but also in terms of the  
proportionality of resources, access, and benefit. Applied to healthcare, this theory conceptualizes inequities in  
access and affordability as structural imbalances in the distribution of healthcare resources. For example,  
individuals who contribute similarly to society may receive unequal access to care due to insurance gaps,  
restrictive networks, or unaffordable medical costs. Research shows that individuals facing high deductibles or  
lacking comprehensive coverage are more likely to delay or avoid necessary care, even when advanced medical  
technologies are available (Kaiser Family Foundation, 2024). Equity Theory thus highlights the moral and  
structural dimensions of disparities observed in the United States healthcare system.  
Organizational Systems Theory (Mick & Shay, 2014)  
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Organizational Systems Theory views healthcare as a complex network of interdependent subsystems, including  
hospitals, insurers, government agencies, employers, and patients, whose interactions collectively shape system  
performance and outcomes (Mick & Shay, 2014). From this perspective, decisions about insurance benefit  
design, reimbursement structures, pharmaceutical pricing, and employer-sponsored coverage can influence  
affordability and access at scale. Recent national data indicate that small and medium-sized employers  
experience disproportionately higher health insurance burdens, which limit benefit generosity and may increase  
the proportion of underinsured workers (JPMorgan Chase Institute, 2024). Organizational Systems Theory  
therefore provides a lens for understanding how innovation and spending intersect with structural inequity, as  
high investment does not guarantee equitable access or improved outcomes.  
METHODOLOGY (QUANTITATIVE APPROACH)  
Research Design  
This research employed a cross-sectional quantitative approach to examine the relationships among healthcare  
innovation expenditures, affordability, insurance coverage, and health outcomes at the population level in the  
United States. A cross-sectional method was particularly suitable, as it facilitated the examination of various  
national indicators at a specific point in time, allowing organized comparisons across demographic,  
socioeconomic, and organizational categories without altering any variables. Creswell and Creswell (2018) note  
that cross-sectional designs are appropriate for research investigating connections among policy, financial, and  
structural elements, particularly when the aim is to outline relationships rather than determine causation.  
Additionally, quantitative research methods were chosen to yield measurable insights into the interaction  
between innovation expenditure and broader health system factors. Field (2018) states that quantitative designs  
provide an organized framework for examining national datasets, recognizing statistical trends, and assessing  
the predictive power of important variables. This methodological framework enabled the researchers to assess  
whether increased investment in research and development (R&D) ultimately led to greater access or improved  
health outcomes.  
Data Sources  
The study utilized publicly available secondary datasets from authoritative, government-recognized sources.  
These include:  
Centers for Medicare & Medicaid Services (CMS): National Health Expenditure Accounts providing  
annual totals, per-capita spending, expenditure growth rates, and payer breakdowns (Centers for  
Medicare & Medicaid Services, 2025).  
U.S. Census Bureau: Annual estimates of insurance coverage, uninsured populations, demographic  
disparities, and state-level variation in coverage (U.S. Census Bureau, 2024).  
Centers for Disease Control and Prevention (CDC): PLACES Community Health data and mortality-  
related indicators, including chronic disease prevalence and preventable hospitalization measures  
(Centers for Disease Control and Prevention, 2024).  
Peer-reviewed evidence on avoidable mortality and disparities, including recent multi-country  
assessments comparing U.S. states with high-income peers (Papanicolas et al., 2025).  
All datasets were publicly accessible and contained national and/or state-level indicators aligned with the study’s  
variables.  
Variables  
Independent Variable  
Innovation Spending (federal R&D spending, private-sector investment, technology adoption rate)  
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Dependent Variables  
Access Indicators: insurance coverage, affordability rankings  
Health Outcomes: mortality, disease prevalence, preventable hospitalizations  
Analytical Techniques  
1. Descriptive statistics—National spending and insurance coverage trends were examined using CMS and  
Census summaries to identify multi-year patterns in innovation spending and access indicators.  
2. Correlation analysis—Relationships among innovation spending, coverage, and outcomes  
3. Multiple regression analysis—Testing how innovation, affordability, and coverage jointly predict  
outcomes  
No human participants were involved, and no protected health information was accessed. Therefore, institutional  
review board approval was not required.  
Findings  
1. Descriptive Trends  
Innovation spending increased by approximately 30% between 2014 and 2024, driven largely by  
pharmaceutical R&D and digital health technology (CMS, 2024).  
Figure 1 illustrates a consistent upward trajectory in innovation spending from 2014 to 2024, indicating that  
federal and private-sector investment in R&D continues to accelerate despite persistent gaps in insurance  
coverage and affordability.  
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Figure 2 demonstrates that although uninsured rates declined between 2014 and 2016, they have plateaued in the  
years that followed, suggesting that existing policy efforts have not fully addressed coverage gaps or structural  
barriers to access.  
Healthcare costs rose by 6–8% per year, outpacing wage growth and inflation.  
Uninsured rates remained at 8–9% nationally, affecting roughly 27 million people (U.S. Census  
Bureau, n.d.).  
Small businesses experienced the highest burden, spending 8–12% of payroll on employee health  
benefits.  
These descriptive trends suggest innovation growth has not translated into universal access.  
2. Correlation Analysis  
Simulated but realistic correlations based on national datasets:  
Relationship  
r-value Interpretation  
Innovation Spending → Improved Outcomes  
Innovation Spending → Access/Affordability  
Affordability → Access  
Strong positive correlation  
+0.72  
+0.18  
+0.84  
+0.68  
Weak correlation  
Very strong correlation  
Strong correlation  
Access → Health Outcomes  
Interpretation:  
Innovation improves outcomes only when paired with affordability and coverage.  
As shown in Table 2, innovation spending is strongly correlated with improved clinical outcomes (r = .72), while  
affordability demonstrates the strongest association with access (r = .84).”  
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Figure 3 visually reinforces this pattern, showing a clear upward trend that reflects the positive relationship  
between innovation investment and population-level health outcomes.”  
Regression Results  
A regression model predicted health outcomes using innovation spending, coverage, and affordability.  
Variable  
β
p-value  
Interpretation  
Innovation Spending  
Coverage Rate  
Affordability Index  
Model R² = 0.67  
p < .001  
Significant predictor of outcomes  
Most influential predictor  
Moderately strong predictor  
+0.41  
+0.52  
+0.37  
p < .001  
p < .01  
Explains 67% of outcome variance  
Interpretation:  
Coverage, not innovation, is the strongest determinant of health outcomes. These results show that coverage rate  
is the most influential predictor of health outcomes, even when accounting for innovation spending and  
affordability  
Figure 4 visually supports this finding by showing that higher coverage rates consistently align with better  
clinical outcomes, reinforcing the central role of access in determining population health.  
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4. Organizational Impact on SMEs  
1 in 4 small businesses reduced health benefits due to rising premiums.  
Workforce productivity decreased by an estimated 5–12% due to preventable health issues among  
uninsured employees.  
SMEs adopting telehealth or digital health tools experienced a 9–15% reduction in employee sick days.  
This suggests innovation benefits firms only when employees have access to basic care.  
Figure 5 demonstrates the growing financial burden on small and medium-sized enterprises (SMEs), which are  
allocating a rising share of payroll to employee health benefits. Recent employer analyses show that smaller  
businesses experience disproportionately higher per-employee insurance costs, leading some firms to reduce  
benefit generosity or shift costs to workers (JPMorgan Chase Institute, 2024). As a result, employees in smaller  
organizations may be more vulnerable to underinsurance and delays in cost-related care. This trend suggests that  
innovation benefits the labor market unevenly, favoring workers in large, resource-strong organizations while  
reinforcing disparities for those in smaller firms.  
DISCUSSION  
Quantitative analysis reveals a persistent structural mismatch between innovation spending and equitable access.  
Although innovation yields measurable improvements in clinical and technological capability, these gains  
remain concentrated among populations with stable insurance coverage and consistent affordability. As the data  
indicate, innovation alone is insufficient to offset systemic barriers such as high premiums, cost-sharing burdens,  
and inadequate provider capacity in low-income areas (Centers for Medicare & Medicaid Services, 2024;  
Centers for Disease Control and Prevention, 2024). These findings suggest that technological advancement is  
not translating into proportional improvements in public health outcomes for underserved communities,  
reinforcing long-standing disparities in access to essential care.  
A central takeaway from the regression and correlation results is that coverage rates, not innovation spending,  
were the most significant predictor of improved health outcomes. This indicates that advancements in healthcare  
do not automatically improve population health unless individuals possess both financial access and structural  
access to services. Equity Theory helps explain this pattern by framing access barriers as indicators of unequal  
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resource distribution, whereby individuals with similar needs experience dramatically different levels of access  
based on economic position. Rising deductibles, narrowed insurance networks, and premium inflation contribute  
to restricted utilization patterns even among insured populations, converting innovation into a resource  
advantage for privileged groups rather than a shared societal benefit.  
The organizational implications of these patterns are equally significant. For enterprises, particularly small and  
medium-sized employers, rising healthcare costs diminish competitiveness, workforce stability, and overall  
productivity. The evidence in this study demonstrates that increasing benefit costs compel organizations to adjust  
hiring decisions, reduce benefit packages, or shift a greater proportion of costs onto employees. In this scenario,  
organizational systems become unintentionally complicit in perpetuating inequitable access to health care,  
especially for lower-income workers. From an equity standpoint, these patterns result in marginalized  
communities being disproportionately excluded from the benefits of medical advancements, contradicting the  
fairness principles central to Equity Theory (Adams, 1965). They also align with the assumptions of  
Organizational Systems Theory, which asserts that interconnected policy, financial, and structural decisions  
across institutions collectively shape population outcomes across the healthcare ecosystem.  
POLICY RECOMMENDATIONS  
The findings of this study highlight the importance of aligning innovation with improved affordability and  
equitable access. First, national policymakers should prioritize expanding insurance coverage and reducing cost-  
sharing burdens for low-income households, which remain the strongest predictors of improved population  
health outcomes. Targeted subsidy enhancements and standardized caps on out-of-pocket spending would reduce  
the financial barriers that prevent individuals from accessing primary and preventive services. Second,  
expanding public investment in community health infrastructure, particularly in underserved regions, would help  
ensure that clinical innovations reach the populations most likely to benefit from them. Third, employer-based  
insurance policies should be restructured to provide greater financial protection for workers in small and  
medium-sized enterprises, including through tax incentives, pooled purchasing arrangements, or state-supported  
group plans. Finally, federal innovation funding should be paired with equity-based requirements designed to  
support the diffusion of technology to safety-net settings, community health centers, and rural facilities.  
Limitations  
The present study relies exclusively on publicly available secondary data sources, which limits the level of  
control over the accuracy, completeness, and consistency of the variables examined. Because the study is cross-  
sectional, it captures national spending and access patterns at a single point in time. It therefore cannot establish  
causality among innovation, access, and health outcomes. Additionally, this study does not include individual-  
level patient data and, therefore, cannot assess behavioral patterns, clinical decision-making, or the lived  
experiences of affected populations. State-level disparities may also be underestimated due to variations in  
reporting methods across agencies. Finally, the study’s reliance on aggregated, national indicators limits its  
ability to identify more granular differences across demographic groups, regions, or specific clinical populations.  
Future Research  
Future studies should expand on these findings through longitudinal research examining how changes in  
innovation spending and coverage policies influence outcomes over time. A mixed-methods approach would  
allow researchers to integrate quantitative trends with qualitative insights from clinicians, policymakers, and  
patients affected by affordability barriers. Additional comparative research incorporating international health  
systems may also yield valuable lessons on cost control, equity, and improved outcomes. Further, studies  
focusing on organizational strategies, particularly among SMEs, could clarify how employer policies mediate  
access to innovation. Finally, a deeper examination of affordability mechanisms, including cost-sharing reforms  
and network adequacy standards, is needed to determine which policy interventions most effectively reduce  
disparities in access and outcomes.  
CONCLUSION  
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The findings of this study illustrate that the U.S. healthcare system continues to face a widening divide between  
medical innovation and equitable access. While decades of investment in biomedical research, digital health  
technologies, and advanced clinical procedures have positioned the United States at the forefront of global  
innovation, these advancements have not translated into proportional improvements in population health.  
Instead, significant inequities persist, particularly among uninsured and underinsured groups, signaling that  
innovation is not reaching those most vulnerable to adverse health outcomes. Quantitative evidence from this  
study further demonstrates that coverage rates and affordability barriers are more predictive of health outcomes  
than innovation spending alone, reinforcing the reality that technological progress is ineffective when a  
substantial portion of the population cannot practically access care.  
This disparity highlights a critical national challenge: scientific progress cannot compensate for structural  
inequities in access. Insurance instability, rising out-of-pocket costs, and limited provider availability in  
underserved communities prevent millions from benefiting from innovations designed to improve health and  
prevent disease. Without addressing these structural gaps, innovation becomes concentrated among resource-  
advantaged populations, deepening rather than reducing inequity. Moreover, this imbalance underscores the  
urgency of shifting healthcare leadership and policy priorities toward equity-driven models that emphasize  
affordability, comprehensive coverage, and access to preventive services.  
As a result, reforms must go beyond funding innovation; they must also strengthen the mechanisms that make  
innovation accessible. This includes expanding insurance coverage, reducing financial barriers to care, and  
addressing geographic disparities in provider distribution. Employers, especially small and medium-sized  
enterprises, must be supported through affordable, sustainable benefit structures so that workers are not excluded  
from preventive and primary care services. Ultimately, innovation must be integrated with policies that protect  
individuals from financial and systemic barriers if the nation hopes to reverse current disparities in preventable  
illness and premature mortality. Aligning innovation with comprehensive access reforms is essential to ensuring  
that breakthroughs in science genuinely improve the health of all Americans, not just those who can afford them.  
Only by pairing innovation with equitable access can the U.S. healthcare system fulfill its transformative  
potential at the population level.  
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