Healthcare in the          United StatesPresented by: Philip Geanacopoulos   2012.11.30
What We Will Cover Today1. Big Picture Orientation2. What Makes the US System Different3.   What is Health Insurance in th...
What We Will Cover Today1. Big Picture Orientation2.   What Makes the US System Different3.   What is Health Insurance in ...
Some Statistics About the   US Government For 2012:  US Tax Revenue                $2.469 trillion  Federal Budget        ...
Let’s Pretend It’s a       Household BudgetAnnual Family Income        $24,690Money the Family Spent      $37,796New Debt ...
Where Does All That Money Go  Medicare/Medicaid              $755 billion  Social Security                $778 billon  Def...
DefinitionGDP – Gross Domestic Product  • The total monetary value of all the finished goods and    services produced with...
GDP – Top 5 Economies       $18       $16                                                              $15.31 trillion    ...
US Healthcare System Spending
Total National Health Spending             Continues to Increase    3                                                     ...
U.S. Spends More than                                    Expected Based on Its Wealth                                   $9...
Per Capita Spending on Healthcare
What Does $8,402 Per Person Buy?                        Public       Investment, $483         16% of spending             ...
U.S. Health Spending is a Dramatic      Outlier Internationally   United States    Netherlands                            ...
U.S. Pays More for Hospital Services           Composite Index, 29 Inpatient Services           Comparative Price Levels, ...
U.S. Pays More for Hospital Services                                Select Countries & Services(US$, 2009) $35,000        ...
U.S. Physicians Earn More                          Particularly Specialists$500,000               Australia          Canad...
U.S. Pays Physicians More for the Same Services                             Especially Private Payers and Specialty Care  ...
What We Will Cover Today1. Big Picture Orientation2. What Makes the US System Different3.   What is Health Insurance in th...
What Makes the       US System Difference• All major developed countries except for the United  States offer national heal...
What Makes the         US System Difference• No Central Governing Agency• Technology-Driven and Focuses on Short-Term Trea...
What Makes the       US System Difference• The US invests in research and innovations in new  medical technology.• The US ...
$1.9 million da Vinci  Surgical System
Seeing a Doctor
HIPAAHealth Insurance Portability and Accountability Act:• A US law designed to provide privacy standards to  protect pati...
What We Will Cover Today1. Big Picture Orientation2. What Makes the US System Different3. What is Health Insurance in the ...
DefinitionsHealth Insurance  • A contract between an insurance provider and an    individual and used for insuring against...
DefinitionsMedicaid  • A health program for low income people and families paid    by the federal government and respectiv...
DefinitionsEmployer Based Health Insurance  • A health program where employers pay the cost of    health insurance for the...
Who is Able to           Access HealthcarePeople Who:  1. Have health insurance through an employer  2. Are covered under ...
Health Insurance in the US     Private Health                                        Uninsured       Insurance            ...
What We Will Cover Today1. Big Picture Orientation2. What Makes the US System Different3.   What is Health Insurance4. Dia...
Diabetes Costs• According to the American Diabetes Association, 25.8  million Americans are currently diagnosed with diabe...
Diabetes Costs• Total annual health care costs for a person with diabetes  was more than $11,744 in 2007 according to the ...
Expected Medical           Costs for DiabetesThe most common expenses for diabetics areprescription medications including ...
Diabetes Medications• A 500-millgram dose of metformin (二甲双胍)  costs on average $18 a month, found in stores like  Wal-Mar...
Diabetes Supplies• Blood glucose monitors range from $10 to  $80, depending on the model.• Test strips average $0.60 to $0...
Insurance Coverage for          Diabetes Patients• These medications and supplies are not covered all  by insurance so thi...
Medicare & Diabetes    Related Medical Expenses• Medicare covers supplies for people with  diabetes, whether or not they u...
Medicare Payments• Medicare will pay 75% of all drug costs after a $250  deductible is paid, up to $2,250. Medicare will p...
What We Will Cover Today1. Big Picture Orientation2. What Makes the US System Different3.   What is Health Insurance4.   D...
Who Pays?• Insurance Companies – Employer Based or  Purchased Privately• The Government    • Medicaid    • Medicare    • M...
Payment –         Insurance Companies• The cost of health insurance will depend on your  age, how healthy you are, where y...
Payment –              US Government• Helps to pay for insurance for the elderly and those  below the poverty line through...
Payment –                Out of Pocket• Two options: to buy health insurance or to hope they do  not need to use the healt...
Emergency Room Care• US law requires all hospitals to accept all  patients, regardless of the ability to pay, for  Emergen...
Who Wins?
Profits• The top executives at the five largest for-profit health  insurance companies in the United States combined to  r...
Who Loses?            Who’s uninsured?                                            Nearly 50 million, or 16.4%             ...
Uninsured and Death• Lack of health insurance is associated with as many  as 44,789 deaths per year in the United States.•...
Why Are People Uninsured1. Unemployment2. Lack of a requirement for employers to provide   insurance3. Lack of a requireme...
What We Will Cover Today1. Big Picture Orientation2. What Makes the US System Different3.   What is Health Insurance4.   D...
What’s the Problem?US System Has:  •   Duplication  •   Overlap  •   Inadequacy  •   Inconsistency  •   Complexity  •   In...
$3 Out of Every $10 is Waste  Missed            Fraud                  $75 billion                           Unnecessary P...
Healthcare Prices• So what would happen if shopping were like U.S.  health care? "Product prices would not be  posted, and...
Fraud
Relatively Few People Account                                       for Most Personal Health Spending                     ...
Annual Costs of Chronic Disease  Heart Disease & Stroke    $448 billon  Smoking & Tobacco Use     $193 billion  Diabetes  ...
WHO Health Care Rankings            1. France           18. England          25. Germany           30. Canada          36....
Life Expectancy
What We Will Cover Today1. Big Picture Orientation2. What Makes the US System Different3.   What is Health Insurance4.   D...
Some Positives in the US       Healthcare System• The U.S. has one of the best medical research systems in  the world. Res...
Some Positives in the US       Healthcare System• The Medicaid program gives Americans who are poor a  chance to receive s...
Free Health Clinic
What Does the Future             Look Like• From 2011 to 2015, the commercial health insurance  system will convert from c...
US Health System
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  • It would be like going on vacation, flying to some exotic location, staying in a nice hotel, eating delicious food. The problem is, you have no idea how much is all costs. You don’t find out until a month later when you receive a bill in the mail telling you how much it all cost and how much you owe.
  • US Health System

    1. 1. Healthcare in the United StatesPresented by: Philip Geanacopoulos 2012.11.30
    2. 2. What We Will Cover Today1. Big Picture Orientation2. What Makes the US System Different3. What is Health Insurance in the US4. Diabetes and Associated Costs5. Who Pays, Who Wins and Who Loses6. What’s the Problem7. Some Positives
    3. 3. What We Will Cover Today1. Big Picture Orientation2. What Makes the US System Different3. What is Health Insurance in the US4. Diabetes and Associated Costs5. Who Pays, Who Wins and Who Loses6. What’s the Problem7. Some Positives
    4. 4. Some Statistics About the US Government For 2012: US Tax Revenue $2.469 trillion Federal Budget $3.796 trillion New Debt -$1.327 trillion Total US Government Debt -$14.7 trillion1 trillion dollars = $1,000,000,000,000万亿
    5. 5. Let’s Pretend It’s a Household BudgetAnnual Family Income $24,690Money the Family Spent $37,796New Debt on Credit Card -$13,270Outstanding Balance on CC -$147,210
    6. 6. Where Does All That Money Go Medicare/Medicaid $755 billion Social Security $778 billon Defense $700 billion Health, Education, Transport $646 billion Debt Interest $227 billion Other $545 billion Total $3.7 trillion
    7. 7. DefinitionGDP – Gross Domestic Product • The total monetary value of all the finished goods and services produced within a country in a specific time period, typically one year
    8. 8. GDP – Top 5 Economies $18 $16 $15.31 trillion $14 $12USAChina $10Japan $8 $8.23 trillionGermany $6 $5.82trillionFrance $4 $3.61 trillion $2.85 trillion $2 $0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Source: World Bank (2012); GDP in trillions
    9. 9. US Healthcare System Spending
    10. 10. Total National Health Spending Continues to Increase 3 $8,402 $9,000 National Health Expenditures (trillions) $8,149 $7,911 $7,628 $8,000 Per Capita Health Spending $7,251 2.5 $6,868 2.6 $6,488 2.5 $7,000 $6,114 2.4 2.3 2 $5,687 2.2 $6,000 $5,241 2.0 $4,878 1.9 $4,601 $5,000 $4,367 1.8 1.5 $4,169 1.6 1.5 $4,000 1.4 1.3 1 1.1 1.2 $3,000 $2,000 0.5 $1,000 0 $0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010% GDP 13.7% 13.7% 13.8% 13.8% 14.5% 15.4% 15.9% 16.0% 16.1% 16.2% 16.4% 16.8% 17.9% 17.9%
    11. 11. U.S. Spends More than Expected Based on Its Wealth $9,000 United StatesPer Capita Health Spending, 2011 $8,000 $7,000 Chile, Mexico, Poland, $6,000 Estonia, Hungary, Slova Switzerland Norway $5,000 k Republic, Czech Luxembourg Republic, Korea, Israel, $4,000 Slovenia, New Zealand $3,000 $2,000 Spain, Italy, France, Finland, United Kingdom, Belgium, Germany, Iceland, Sweden, D $1,000 enmark, Canada, Austria, Ireland, Netherlands $0 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 Per Capita Income, 2011
    12. 12. Per Capita Spending on Healthcare
    13. 13. What Does $8,402 Per Person Buy? Public Investment, $483 16% of spending Health, $267 Administration, $ ($1,320) is not 570 related to personal health care services Rx, DME & Hospital Other Medical Care, $2,637Products, $1,106 Home 84% of spendingHealthcare, $1,10 ($7,080) is for 7 Doctor & Clinical personal health Services, $1,670 care services Dentists & Other Health Professionals, $56 0
    14. 14. U.S. Health Spending is a Dramatic Outlier Internationally United States Netherlands 17.9 France Germany Denmark Switzerland Canada Austria Belgium New Zealand SwedenUnited Kingdom Iceland Norway Spain Most developed Italy Ireland countries spent Slovenia Finland ~9.5 to 12% ofSlovak Republic Chile GDP on health Czech Republic Israel care in 2009 Luxembourg Poland Hungary Estonia Korea Mexico % GDP, 2010 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0
    15. 15. U.S. Pays More for Hospital Services Composite Index, 29 Inpatient Services Comparative Price Levels, Hospital Services, 2009United States 164 Italy 140 Australia 123 France 121 U.S. hospital Sweden 114 prices 64% Canada 113 higher than Finland 98 OECD average Portugal 85 Israel 62 Slovenia 59 Korea 57 0 20 40 60 80 100 120 140 160 180 OECD – Organization for Economic Co-operation and Development
    16. 16. U.S. Pays More for Hospital Services Select Countries & Services(US$, 2009) $35,000 $34,358 Australia$30,000 Canada$25,000 France Sweden$20,000 United States $21,218 $17,406$15,000 $11,162$10,000 $7,962 $8,917 $4,451 $4,558 $5,000 $2,591 $3,093 $0 Normal Delivery Appendectomy Heart Surgery Hip Replacement Hernia Repair
    17. 17. U.S. Physicians Earn More Particularly Specialists$500,000 Australia Canada France Germany UK US 442,450$450,000$400,000$350,000 324,138$300,000$250,000 186,582 187,609 208,634 202,771$200,000 159,532 154,380$150,000 125,104 131,809 92,844 95,585$100,000 $50,000 $0 Primary Care Physicians Orthopedic Surgeons
    18. 18. U.S. Pays Physicians More for the Same Services Especially Private Payers and Specialty Care Primary Care - Office Visit Fees Specialty Care – Hip Replacement$140 133 $4,500 129 3,996 $4,000$120 104 $3,500$100 $3,000 $80 $2,500 66 2,160 59 60 1,943 $60 $2,000 46 45 1,634 1,340 $1,500 1,251 $40 34 32 34 1,046 $1,000 1,181 674 $20 $500 652 $0 $0 Public Payers Private Payers Public Payers Private Payers Australia Canada France Germany UK US Australia Canada France Germany UK US
    19. 19. What We Will Cover Today1. Big Picture Orientation2. What Makes the US System Different3. What is Health Insurance in the US4. Diabetes and Associated Costs5. Who Pays, Who Wins and Loses6. What’s the Problem7. Some Positives
    20. 20. What Makes the US System Difference• All major developed countries except for the United States offer national health care programs.• These programs provide universal access through health care delivery systems that are managed by the respective governments and provide a defined set of healthcare services to all citizens.
    21. 21. What Makes the US System Difference• No Central Governing Agency• Technology-Driven and Focuses on Short-Term Treatment• High on Cost, Unequal in Access, and Average in Outcomes• Imperfect Market Conditions• Government as Subsidiary to the Private Sector• Market Justice vs. Social Justice• Multiple Players and Balance of Power• Quest for Integration and Accountability
    22. 22. What Makes the US System Difference• The US invests in research and innovations in new medical technology.• The US accounts for three quarters of the world’s biotechnology revenues and 82% of the world R&D spending in biotechnology.• Growth in science and technology helps create demand for new services.
    23. 23. $1.9 million da Vinci Surgical System
    24. 24. Seeing a Doctor
    25. 25. HIPAAHealth Insurance Portability and Accountability Act:• A US law designed to provide privacy standards to protect patients medical records and other health information provided to health plans, doctors, hospitals and other health care providers.• These standards provide patients with access to their medical records and more control over how their personal health information is used and disclosed.
    26. 26. What We Will Cover Today1. Big Picture Orientation2. What Makes the US System Different3. What is Health Insurance in the US4. Diabetes and Associated Costs5. Who Pays, Who Wins and Loses6. What’s the Problem7. Some Positives
    27. 27. DefinitionsHealth Insurance • A contract between an insurance provider and an individual and used for insuring against the risk of incurring medical expensesUninsured • A person without health insurancePrivate Self-Purchase • A person who pays out of their own pocket for health services
    28. 28. DefinitionsMedicaid • A health program for low income people and families paid by the federal government and respective statesMedicare • A national social insurance program administered by the federal government that guarantees access to health insurance for Americans ages 65 and older; and younger people with disabilities as well as people with end stage renal diseases - Total government spending for both programs in 2011 was $755 billion
    29. 29. DefinitionsEmployer Based Health Insurance • A health program where employers pay the cost of health insurance for their employees • Employees share some of the expenses through payments including premiums, co-payments and deductiblesPrivate Health Insurance Plan • Health coverage for an individual and usually more expensive than Employer Based Health Insurance
    30. 30. Who is Able to Access HealthcarePeople Who: 1. Have health insurance through an employer 2. Are covered under a government program 3. Can afford to buy health insurance out-of-pocket 4. Are able to pay for services privately
    31. 31. Health Insurance in the US Private Health Uninsured Insurance 8% 16% Medicaid 18% 49% Employer - Based 13% Medicare Total = 307.9 million Military
    32. 32. What We Will Cover Today1. Big Picture Orientation2. What Makes the US System Different3. What is Health Insurance4. Diabetes and Associated Costs5. Who Pays, Who Wins and Who Loses6. What’s the Problem7. Some Positives
    33. 33. Diabetes Costs• According to the American Diabetes Association, 25.8 million Americans are currently diagnosed with diabetes (8.3 percent of the population) and seven million are currently undiagnosed.• 7th leading cause of death in the US• 79 million American have pre-diabetes• 60% of cases, diabetes is associated with obesity• From a health insurance standpoint, the need for expensive and often lifelong care make diabetes an overwhelming cost driver
    34. 34. Diabetes Costs• Total annual health care costs for a person with diabetes was more than $11,744 in 2007 according to the American Diabetes Association.• Diabetics have medical expenditures more than twice as high as those who do not have diabetes.• Insurance companies are beginning to resist paying for what they view a lifestyle management issue rather than acute medical care.• Estimated to kill 4.8 million Americans in 2012
    35. 35. Expected Medical Costs for DiabetesThe most common expenses for diabetics areprescription medications including insulin, medicalsupplies and equipment.• Insulin syringes• Insulin• Blood glucose test meters and test strips• Injectable medication• Doctor visits
    36. 36. Diabetes Medications• A 500-millgram dose of metformin (二甲双胍) costs on average $18 a month, found in stores like Wal-Mart and Target.• Actos, a newer drug with a different method of action, costs on average $241 for a month’s supply of the 30-milligram pills.
    37. 37. Diabetes Supplies• Blood glucose monitors range from $10 to $80, depending on the model.• Test strips average $0.60 to $0.80 each• Costs not covered by insurance add up to hundreds of dollars a year in out-of-pocket expenses.
    38. 38. Insurance Coverage for Diabetes Patients• These medications and supplies are not covered all by insurance so this leaves a significant cost to the individual diabetic and their family.• Even the insurance plans that cover diabetic prescriptions and supplies may still have significant deductibles, co-payments and other requirements that make the insurance coverage insignificant relative to the overall out of pocket costs.
    39. 39. Medicare & Diabetes Related Medical Expenses• Medicare covers supplies for people with diabetes, whether or not they use insulin. What’s included? • Glucose testing monitors • Blood glucose test strips • Lancet devices and lancets • Glucose control solutions • Therapeutic shoes • Self-management training • Nutrition counseling • Eye exams
    40. 40. Medicare Payments• Medicare will pay 75% of all drug costs after a $250 deductible is paid, up to $2,250. Medicare will pay 0% of drug costs between $2,250 and $5,100 Beyond this amount, Medicare will again pay.• This equals $3,600 out-of-pocket expense for diabetes patients.
    41. 41. What We Will Cover Today1. Big Picture Orientation2. What Makes the US System Different3. What is Health Insurance4. Diabetes and Associated Costs5. Who Pays, Who Wins and Who Loses6. What’s the Problem7. Some Positives
    42. 42. Who Pays?• Insurance Companies – Employer Based or Purchased Privately• The Government • Medicaid • Medicare • Military• Paying Out of Pocket
    43. 43. Payment – Insurance Companies• The cost of health insurance will depend on your age, how healthy you are, where you live, your income and your job status.• There is a fee that must be paid monthly to the insurance company called a premium – Average monthly premium for an American family is $530.• For those who are employed typically have their health insurance paid for by their employer or a large percentage.• If you are self-employed you must pay for your own insurance and the price of the premium will depend on what health insurance plan you choose.
    44. 44. Payment – US Government• Helps to pay for insurance for the elderly and those below the poverty line through Medicare and Medicaid.• Medicare provides health insurance to people who are at least 65 years old.• Medicaid is a health program for those with low incomes and resources. It is jointly funded by the states and federal government.• The poverty rate in 2010 was 15.1 percent—up from 14.3 percent in 2009.
    45. 45. Payment – Out of Pocket• Two options: to buy health insurance or to hope they do not need to use the healthcare system.• Many choose not to pay for insurance and cannot afford health care at regular clinics.• The average expense for a physicians office visit was $155.• As a result, the emergency room of the hospital is abused because it cannot turn people away due to lack of insurance or ability to pay.
    46. 46. Emergency Room Care• US law requires all hospitals to accept all patients, regardless of the ability to pay, for Emergency Room care. • ERs are typically at or over capacity • Long wait times • ERs charge very high rates for services • ―Safety-net‖ for uninsured
    47. 47. Who Wins?
    48. 48. Profits• The top executives at the five largest for-profit health insurance companies in the United States combined to receive nearly $200 million in total compensation for 2010.• According to a report by Health Care for America Now, Americas five biggest for-profit health insurance companies ended 2010 with a combined profit of $12.2 billion.• There were more than two dozen pharmaceutical companies that made over a billion dollars in profits each during 2010.
    49. 49. Who Loses? Who’s uninsured? Nearly 50 million, or 16.4% of Americans are uninsuredBy ethnicity, the rate of those who lack insurance is 15.4% White 20.8% Black 18.1% Asian 30.7% HispanicSource: US Census Bureau
    50. 50. Uninsured and Death• Lack of health insurance is associated with as many as 44,789 deaths per year in the United States.• People without health insurance had a 40 percent higher risk of death than those with private health insurance, a result of being unable to obtain necessary medical care.
    51. 51. Why Are People Uninsured1. Unemployment2. Lack of a requirement for employers to provide insurance3. Lack of a requirement for employees to purchase health insurance when it is offered4. Lack of eligibility for government-funded programs.
    52. 52. What We Will Cover Today1. Big Picture Orientation2. What Makes the US System Different3. What is Health Insurance4. Diabetes and Associated Costs5. Who Pays, Who Wins and Who Loses6. What’s the Problem7. Some Positives
    53. 53. What’s the Problem?US System Has: • Duplication • Overlap • Inadequacy • Inconsistency • Complexity • Inefficiency • Financial manipulation • Fragmentation • Waste
    54. 54. $3 Out of Every $10 is Waste Missed Fraud $75 billion Unnecessary Prevention ServicesOpportunities $210 billion $55 billion Excess InefficientlyAdministration Delivered Costs Services $190 billion $130 billion Prices That Are Too High Source: Economist Intelligence Unit $105 billion
    55. 55. Healthcare Prices• So what would happen if shopping were like U.S. health care? "Product prices would not be posted, and the price charged would vary widely within the same store, depending on the source of payment.‖
    56. 56. Fraud
    57. 57. Relatively Few People Account for Most Personal Health Spending 100 100.0 90 Top 1% of spenders account for >20% of spending ($275 billion)Cumulative Percent of Total Spending 80 78.2 70 Top 5% of spenders account for almost half of spending ($623 billion) 60 50 Total Personal Health Care Spending 50.5 40 = $1.259 Trillion 34.8 $36 Billion $1,223 Billion 30 18.8 20 10.4 10 2.9 5.6 0.0 0.1 0.4 1.3 95 99 0 15.4 0 10 20 30 40 50 60 70 80 90 100 Percent of Population by Health Care Spending
    58. 58. Annual Costs of Chronic Disease Heart Disease & Stroke $448 billon Smoking & Tobacco Use $193 billion Diabetes $174 billion Obesity $117 billion Cancer $89 billion Arthritis $81 billion Pregnancy Complications $1 billion Total $1.1 trillion
    59. 59. WHO Health Care Rankings 1. France 18. England 25. Germany 30. Canada 36. Costa Rica 37. United States 38. Slovenia
    60. 60. Life Expectancy
    61. 61. What We Will Cover Today1. Big Picture Orientation2. What Makes the US System Different3. What is Health Insurance4. Diabetes and Associated Costs5. Who Pays, Who Wins and Who Loses6. What’s the Problem7. Some Positives
    62. 62. Some Positives in the US Healthcare System• The U.S. has one of the best medical research systems in the world. Researchers from institutions such as Harvard Medical School, the Mayo Clinic and the Cleveland Clinic are world-renowned for the advances they are making in medicine, largely because of the current free- market system.• For those who have jobs with great benefits or those who can afford it, some American insurance plans are some of the best in the world.
    63. 63. Some Positives in the US Healthcare System• The Medicaid program gives Americans who are poor a chance to receive some health care for free.• The United States takes care of its elderly population by provided them with a limited plan of healthcare through Medicare and pay for doctor visits and hospital stay.• The State Childrens Health Insurance Program (SCHIP) administered by the Centers for Medicare and Medicaid Services, makes funds available to states that have in place federally approved programs providing health insurance coverage to uninsured children.
    64. 64. Free Health Clinic
    65. 65. What Does the Future Look Like• From 2011 to 2015, the commercial health insurance system will convert from coverage that focuses primarily on covering unexpected medical bills to the management and control of existing and ongoing medical problems like obesity and diabetes.• Insurance coverage is beginning to shift from drug-based therapy to treatment focused on behavioral change.• The healthcare system is changing, with a greater focus of value, reducing errors and giving more quality and cost-effective care.

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