Health care in the USA

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Health and Health Care Systems in the USA

Health and Health Care Systems in the USA

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  • We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative.
    About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.

Transcript

  • 1. Population Health in the USA
  • 2. Health Spending as % of GDP
  • 3. Health Spending as % of GDP 16 12 $(int) 8 4 0 USA Canada Mexico Cuba UK $int
  • 4. Health Spending as % of GDP 16 15.4 12 $(int) 8 4 0 USA Canada Mexico Cuba UK $int
  • 5. Health Spending as % of GDP 16 15.4 12 9.8 $(int) 8 4 0 USA Canada Mexico Cuba UK $int
  • 6. Health Spending as % of GDP 16 15.4 12 9.8 $(int) 8 6.5 4 0 USA Canada Mexico Cuba UK $int
  • 7. Health Spending as % of GDP 16 15.4 12 9.8 $(int) 8 6.5 6.3 4 0 USA Canada Mexico Cuba UK $int
  • 8. Health Spending as % of GDP 16 15.4 12 9.8 $(int) 8 8.1 6.5 6.3 4 0 USA Canada Mexico Cuba UK $int
  • 9. Total per capita expenditure on Health
  • 10. Total per capita expenditure on Health 7,000 5,250 $(int) 3,500 1,750 0 USA Canada Mexico Cuba UK $int
  • 11. Total per capita expenditure on Health 7,000 6,096 5,250 $(int) 3,500 1,750 0 USA Canada Mexico Cuba UK $int
  • 12. Total per capita expenditure on Health 7,000 6,096 5,250 $(int) 3,500 3,173 1,750 0 USA Canada Mexico Cuba UK $int
  • 13. Total per capita expenditure on Health 7,000 6,096 5,250 $(int) 3,500 3,173 1,750 655 0 USA Canada Mexico Cuba UK $int
  • 14. Total per capita expenditure on Health 7,000 6,096 5,250 $(int) 3,500 3,173 1,750 655 0 229 USA Canada Mexico Cuba UK $int
  • 15. Total per capita expenditure on Health 7,000 6,096 5,250 $(int) 3,500 3,173 2,560 1,750 655 0 229 USA Canada Mexico Cuba UK $int
  • 16. Life expectancy
  • 17. Life expectancy 81.00 80 81 78 79 77 76 75 75 75 72 60.75 40.50 20.25 0 M F M F M F M F M F USA Canada Mexico Cuba UK
  • 18. Under 5 Mortality
  • 19. Under 5 Mortality 30.0 22.5 21.1 15.0 7.5 7.9 6.8 5.9 0 USA Canada Mexico Cuba per 1,000 lb
  • 20. Adult Mortality Rate (aged 15-60 per 1,000)
  • 21. Adult Mortality Rate (aged 15-60 per 1,000) 200 162 150 137 128 100 101 90 94 81 83 62 50 56 0 M F M F M F M F M F USA Canada Mexico Cuba UK
  • 22. Ideology and Culture
  • 23. Ideology and Culture Libertarian Individualism
  • 24. Ideology and Culture Libertarian Individualism Conservative
  • 25. Ideology and Culture Libertarian Individualism Conservative National Identity
  • 26. Ideology and Culture Libertarian Individualism Conservative Ethnic and Cultural Origins National Identity
  • 27. Ideology and Culture Libertarian Individualism Conservative Ethnic and Cultural Origins National Identity National Legislation- Federal
  • 28. Ideology and Culture Libertarian Individualism Conservative Ethnic and Cultural Origins National Identity Local Legislation- State National Legislation- Federal
  • 29. Ideology and Culture Libertarian Individualism Conservative Ethnic and Cultural Origins National Identity Local Legislation- State National Legislation- Federal Influence of Religious Right
  • 30. Ideology and Culture Libertarian Individualism Conservative Ethnic and Cultural Origins National Identity Local Legislation- State National Legislation- Federal Influence of Religious Separation of Religion and State Right
  • 31. Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2006 (*BMI ≥30, or about 30 lbs. overweight for 5’4” person) 1990 1998 2006 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: CDC Behavioral Risk Factor Surveillance System.
  • 32. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 33. Diabetes 20.8 Million (7%) Americans are diabetic 54 Million Americans are ‘pre diabetic’ American Indians (18%) Non Hispanic Blacks (16%) Hispanic/Latino (14%) Non Hispanic Whites (8%)
  • 34. Cortland County, NY.
  • 35. Cortland County, NY.
  • 36. Cortland County, NY.
  • 37. Rural Experiences
  • 38. Social Indicators Teen preg. Child Abuse Calls
  • 39. Social Indicators Teen preg. Child Abuse Calls 40 30 Per 1000 pop 20 10 0 Cortland NY State
  • 40. Social Indicators Teen preg. Child Abuse Calls 40 40.0 30 Per 1000 pop 20 18.3 10 0 Cortland NY State
  • 41. Social Indicators Teen preg. Child Abuse Calls 40 40.0 30 Per 1000 pop 20 22.1 18.3 10 9.1 0 Cortland NY State
  • 42. Drunk Driving DWI arrests Under 20 DWI
  • 43. Drunk Driving DWI arrests Under 20 DWI 60 45 Per 10,000 30 15 0 Cortland NY State
  • 44. Drunk Driving DWI arrests Under 20 DWI 60 56.2 45 Per 10,000 30 25.3 15 0 Cortland NY State
  • 45. Drunk Driving DWI arrests Under 20 DWI 60 56.2 54.2 45 Per 10,000 30 30.9 25.3 15 0 Cortland NY State
  • 46. Social indicators Unemployment High School Droputs
  • 47. Social indicators Unemployment High School Droputs 6.0 4.5 3.0 % 1.5 0 Cortland NY State
  • 48. Social indicators Unemployment High School Droputs 6.0 6 6 4.5 3.0 % 1.5 0 Cortland NY State
  • 49. Social indicators Unemployment High School Droputs 6.0 6 6 4.5 4 3.0 % 2 1.5 0 Cortland NY State
  • 50. Average Income
  • 51. Average Income $50,000 $46,195 $37,500 $34,867 $25,000 $12,500 $0 Cortland NY State
  • 52. Physical Activity Moderate 30 x 5 Vigorous 20mins x 3
  • 53. Physical Activity Moderate 30 x 5 Vigorous 20mins x 3 70.0 52.5 35.0 17.5 0
  • 54. Medicare
  • 55. Medicare • Department of Health and Human Services
  • 56. Medicare • Department of Health and Human Services • Social insurance covering 43 Million Americans
  • 57. Medicare • Department of Health and Human Services • Social insurance covering 43 Million Americans • 65+ US citizens or permanent legal resident for 5 yrs
  • 58. Medicare • Department of Health and Human Services • Social insurance covering 43 Million Americans • 65+ US citizens or permanent legal resident for 5 yrs • Or under 65 with permanent disability social security benefit for more than 24 months
  • 59. Medicare • Department of Health and Human Services • Social insurance covering 43 Million Americans • 65+ US citizens or permanent legal resident for 5 yrs • Or under 65 with permanent disability social security benefit for more than 24 months • End stage renal disease, renal failure,
  • 60. Finance
  • 61. Finance • Payroll tax- 1.45% worker/ 1.45% employer
  • 62. Finance • Payroll tax- 1.45% worker/ 1.45% employer • Total medicare spending $440 billion (2007) 16% of all federal spending
  • 63. Hospital care
  • 64. Hospital care • At least 3 days (midnights) not counting discharge day
  • 65. Hospital care • At least 3 days (midnights) not counting discharge day • Nursing home stay for conditions connected to hospital stay (eg. Post surgery rehab)
  • 66. Hospital care • At least 3 days (midnights) not counting discharge day • Nursing home stay for conditions connected to hospital stay (eg. Post surgery rehab) • Only “Skilled Care” covered for up to 100 days
  • 67. Hospital care • At least 3 days (midnights) not counting discharge day • Nursing home stay for conditions connected to hospital stay (eg. Post surgery rehab) • Only “Skilled Care” covered for up to 100 days • First 20 days full cost
  • 68. Hospital care • At least 3 days (midnights) not counting discharge day • Nursing home stay for conditions connected to hospital stay (eg. Post surgery rehab) • Only “Skilled Care” covered for up to 100 days • First 20 days full cost • 80 days part payment (above $128)
  • 69. Hospital care • At least 3 days (midnights) not counting discharge day • Nursing home stay for conditions connected to hospital stay (eg. Post surgery rehab) • Only “Skilled Care” covered for up to 100 days • First 20 days full cost • 80 days part payment (above $128) • After 100 days must have a gap of 60+ days before eligible for more care support
  • 70. Medicines and other out patient costs
  • 71. Medicines and other out patient costs • Optional cover • Local and National Determinations of Cover • Outpatient procedures • Physician, nursing, x-ray, laboratory and other diagnostic tests • Canes, walking and mobility aids, • one pair of spectacle after cataract surgery • Oxygen for home use • Influenza and other vaccines • Blood transfusions, renal dialysis • Chemotherapy • Immunosuppresive drugs for organ transplant patients • Medications administered by a physician in the doctor’s office
  • 72. Medicare +
  • 73. Medicare + • Additional or alternative private medical insurance • Equivalent to medicare but may be variable in cover offered • Co payment required for many areas of health care
  • 74. Additional costs
  • 75. Additional costs • Hospital Cover • 10 years+ (40 quarters) contributions $233 per month • Less than 7.5 yrs (30 quarters) Contributions $423 per month • Medicines cover- $89 per months
  • 76. Deductibles
  • 77. Deductibles • 1- 60 days hospital care $1,024
  • 78. Deductibles • 1- 60 days hospital care $1,024 • 61- 90 days $256 per day
  • 79. Deductibles • 1- 60 days hospital care $1,024 • 61- 90 days $256 per day • 91- 150 days $512 per day
  • 80. Deductibles • 1- 60 days hospital care $1,024 • 61- 90 days $256 per day • 91- 150 days $512 per day • $128 per day for skilled nursing home care 21- 100 days
  • 81. Deductibles • 1- 60 days hospital care $1,024 • 61- 90 days $256 per day • 91- 150 days $512 per day • $128 per day for skilled nursing home care 21- 100 days • Blood deductible for first 3 units of blood unless replaced
  • 82. Deductibles • 1- 60 days hospital care $1,024 • 61- 90 days $256 per day • 91- 150 days $512 per day • $128 per day for skilled nursing home care 21- 100 days • Blood deductible for first 3 units of blood unless replaced
  • 83. Payments to providers
  • 84. Payments to providers • Fixed amount per condition not actual treatment costs
  • 85. Payments to providers • Fixed amount per condition not actual treatment costs • “Upcoding” by Physician to cover unexpected costs
  • 86. Payments to providers • Fixed amount per condition not actual treatment costs • “Upcoding” by Physician to cover unexpected costs • Hospitals can keep money not spent on patient (cover shortfall for excess on other patients)
  • 87. problems
  • 88. problems • Number of workers paying contributions compared to claimants falling • Cost of treatments increasing
  • 89. Medicaid
  • 90. Medicaid • Joint state and federal funded entitlement programme
  • 91. Medicaid • Joint state and federal funded entitlement programme • Low income parents, children, seniors and people with disabilities
  • 92. Medicaid • Joint state and federal funded entitlement programme • Low income parents, children, seniors and people with disabilities • State participation is voluntary but all states currently take part
  • 93. Medicaid • Joint state and federal funded entitlement programme • Low income parents, children, seniors and people with disabilities • State participation is voluntary but all states currently take part • Average expenditure 22% of state spending
  • 94. Medicaid • Joint state and federal funded entitlement programme • Low income parents, children, seniors and people with disabilities • State participation is voluntary but all states currently take part • Average expenditure 22% of state spending • Covers 42.9 million Americans
  • 95. Medicaid • Joint state and federal funded entitlement programme • Low income parents, children, seniors and people with disabilities • State participation is voluntary but all states currently take part • Average expenditure 22% of state spending • Covers 42.9 million Americans • 37% of Childbirths
  • 96. Medicaid • Joint state and federal funded entitlement programme • Low income parents, children, seniors and people with disabilities • State participation is voluntary but all states currently take part • Average expenditure 22% of state spending • Covers 42.9 million Americans • 37% of Childbirths • 60% of nursing home care
  • 97. Eligibility
  • 98. Eligibility • Varies from state to state
  • 99. Eligibility • Varies from state to state • Low income plus
  • 100. Eligibility • Varies from state to state • Low income plus • Age
  • 101. Eligibility • Varies from state to state • Low income plus • Age • Pregnancy
  • 102. Eligibility • Varies from state to state • Low income plus • Age • Pregnancy • Blindness
  • 103. Eligibility • Varies from state to state • Low income plus • Age • Pregnancy • Blindness • Disability