Assessing U.S. and International Experience with  Health Reform and Implications for the Future National Chlamydia Coaliti...
Presentation Outline <ul><li>Case for Reform: Coverage, Quality and Cost </li></ul><ul><li>Why U.S. Has Yet to Enact Natio...
Source of Insurance Employer  (55%) Uninsured (15%) Military (1%) Individual (5%) Medicaid (10%) Medicare (13%) Total popu...
Growth in the Uninsured Data: K. Davis,  Changing Course: Trends in Health Insurance Coverage 2000-2008 , The Commonwealth...
Health Insurance Coverage by Poverty Level, 2008 FPL -- The federal poverty level was $22,025 for a family of four in 2008...
Average Family Premium as a Percentage  of Median Family Income, 1999–2020 Source: K. Davis,  Why Health Reform Must Count...
Who are the Uninsured? <ul><li>Working families — 66% of the uninsured are in families with one or more full-time workers ...
Why Health Insurance Matters <ul><li>Uninsured are: </li></ul><ul><ul><li>Less likely to receive medical and dental care a...
Quality of U.S. Health Care <ul><li>Early 1980s: RAND assessed clinical appropriateness for a variety of procedures </li><...
No One is Immune From Quality Deficits Source: McGlynn, B. Colorado College Lecture April 7, 2008 (Data Source Asch et al ...
Money Doesn’t Buy Quality Source: McGlynn, B. Colorado College Lecture April 7, 2008 (Data Source Asch et al 2006)
Total and Per Capita Spending on Health Care, 1965-2005 Source: CBO based on data on spending on health services and suppl...
Projected Growth in Medicare and Medicaid as Percent of GDP   Source: Congressional Budget Office, Projected Federal Spend...
II . Why the U.S. Has Yet to Enact Universal Coverage <ul><li>Difficulty of making major reforms in the American governmen...
Health Reform Requires Imposing Limits  <ul><li>Americans have historically resisted prior attempts to impose limits </li>...
Prior Justifications For Not Enacting Major Coverage Expansion <ul><li>Need to have well-regulated/managed system before i...
Prior Justifications… <ul><li>There are no major health consequences from being uninsured </li></ul><ul><li>Before enactin...
III.  How the U.S. Compares Internationally <ul><li>The comparative data presented in this segment on quality and cost dem...
Infant Mortality Rate National Average and State Distribution International Comparison, 2004 Infant deaths per 1,000 live ...
Mortality Amenable to Health Care Deaths per 100,000 population* Data: E. Nolte and C.M. McKee, &quot;Measuring the Health...
International Health Expenditures  Per Capita, 1980-2005 Data: OECD Health Data 2009 (June 2009)
Percentage of NHE Spent on Health Administration and Insurance, 2003 *Includes claims administration, underwriting, market...
IV . What Will We Do This Time?  <ul><li>The cost of doing nothing is staggering </li></ul><ul><li>Considerable areas of a...
Cost of Inaction Over the  Next Decade (2009-2019) <ul><li>Number of uninsured Americans will rise to between 57 and 65 mi...
State of Play for Congressional Proposals (As of December 1, 2009)   Source: Congressional Budget Office  Net Change in De...
 
Prevention and Wellness Provision Senate Bill House Bill Preventive services Plans must provide coverage, without cost-sha...
Lessons from Implementing  State Health Reform <ul><li>Reform is an evolutionary process </li></ul><ul><ul><li>Massachuset...
<ul><li>Health Safety Net (HSN) total volume for hospitals and community health centers increased by 2% in the first six m...
Need to Get Started Now! <ul><li>Unrealistic to make all needed reforms at once </li></ul><ul><li>Incremental + Vision = S...
Upcoming SlideShare
Loading in …5
×

W. David Helms: Assessing U.S. and International Experience with Health Reform and Implications for the Future

1,010 views

Published on

Assessing U.S. and International Experience with Health Reform and Implications for the Future by W. David Helms, Ph.D, President and CEO, Academy Health

Published in: Economy & Finance, Business
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,010
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
7
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

W. David Helms: Assessing U.S. and International Experience with Health Reform and Implications for the Future

  1. 1. Assessing U.S. and International Experience with Health Reform and Implications for the Future National Chlamydia Coalition Meeting W. David Helms December 3, 2009
  2. 2. Presentation Outline <ul><li>Case for Reform: Coverage, Quality and Cost </li></ul><ul><li>Why U.S. Has Yet to Enact National Health Reform </li></ul><ul><li>How U.S. Compares Internationally </li></ul><ul><li>What Will We Do This Time? </li></ul>
  3. 3. Source of Insurance Employer (55%) Uninsured (15%) Military (1%) Individual (5%) Medicaid (10%) Medicare (13%) Total population Data: K. Davis, Changing Course: Trends in Health Insurance Coverage 2000-2008 , The Commonwealth Fund at Joint Economic Committee hearing, September 10, 2009. 46.3 Million Uninsured, 2008
  4. 4. Growth in the Uninsured Data: K. Davis, Changing Course: Trends in Health Insurance Coverage 2000-2008 , The Commonwealth Fund at Joint Economic Committee hearing, September 10, 2009. Projected estimates Uninsured Projected to Rise to 61 million by 2020 Millions uninsured
  5. 5. Health Insurance Coverage by Poverty Level, 2008 FPL -- The federal poverty level was $22,025 for a family of four in 2008. Data may not total 100% due to rounding. SOURCE: KCMU/Urban Institute analysis of 2009 ASEC Supplement to the CPS.
  6. 6. Average Family Premium as a Percentage of Median Family Income, 1999–2020 Source: K. Davis, Why Health Reform Must Counter the Rising Costs of Health Insurance Premiums, The Commonwealth Fund, August 2009. Projected
  7. 7. Who are the Uninsured? <ul><li>Working families — 66% of the uninsured are in families with one or more full-time workers </li></ul><ul><li>More than half of uninsured workers are ineligible for their firm’s plan or employed by firms that do not offer health benefits </li></ul><ul><li>2/3 have incomes below 200% FPL ($44,100 for a family of 4.) With the average family insurance policy now costing around $12,680, this group cannot afford health insurance without a subsidy. </li></ul><ul><li>Another 23% have incomes from 200-400% FPL. This group would require a sliding scale subsidy to make health insurance affordable </li></ul><ul><li>Minorities — Almost one-third of Hispanics and Native Americans, and 19.4% of African-Americans lack health insurance </li></ul><ul><li>Young adults have the highest uninsured rates; those aged 18-24 and 25-34 have uninsured rates at 28.1 percent and 25.7 percent, respectively. </li></ul><ul><li>More than 9 million children are uninsured. When including those with a coverage gap at some point during the year, that number doubles. It is estimated that almost 75% of these children qualify for public insurance coverage. </li></ul>Source: State of the States , AcademyHealth, 2009
  8. 8. Why Health Insurance Matters <ul><li>Uninsured are: </li></ul><ul><ul><li>Less likely to receive medical and dental care and have substantially higher unmet health care needs </li></ul></ul><ul><ul><li>More likely to receive lower quality of care </li></ul></ul><ul><ul><li>More likely to be hospitalized for preventable conditions </li></ul></ul><ul><ul><li>Have a higher risk of dying in the hospital or shortly after discharge </li></ul></ul><ul><ul><li>More likely to go bankrupt because of high medical bills </li></ul></ul><ul><li>Per IOM, death rate is 25% higher from being uninsured, cancers are detected later </li></ul><ul><li>Reduction in mortality of 10-15% could be expected if uninsured were continuously insured </li></ul><ul><li>Nearly 45,000 deaths each year are associated with a lack of health insurance </li></ul>Source : Alliance for Health Reform. “Health Care Coverage in America: Understanding the Issues and Proposed Solutions,” Updated March 2008.; “Health Insurance and Mortality in US Adults” Wilper et al. Am J Public Health.2009; 99: 2289-2295
  9. 9. Quality of U.S. Health Care <ul><li>Early 1980s: RAND assessed clinical appropriateness for a variety of procedures </li></ul><ul><ul><li>One-third of procedures clinically inappropriate or of uncertain value </li></ul></ul><ul><li>RAND reported in 2003 and 2007 that adults and children receive the standard of care about half the time </li></ul><ul><li>Care for geriatric conditions is poorer than care for general medical conditions </li></ul>Source: McGlynn, B. Colorado College Lecture April 7, 2008
  10. 10. No One is Immune From Quality Deficits Source: McGlynn, B. Colorado College Lecture April 7, 2008 (Data Source Asch et al 2006)
  11. 11. Money Doesn’t Buy Quality Source: McGlynn, B. Colorado College Lecture April 7, 2008 (Data Source Asch et al 2006)
  12. 12. Total and Per Capita Spending on Health Care, 1965-2005 Source: CBO based on data on spending on health services and supplies, as defined in the national health expenditure accounts, maintained by the Centers for Medicare & Medicaid Services. Note: Spending amounts are adjusted for inflation using the gross domestic product implicit price deflator from the Bureau of Economic Analysis.
  13. 13. Projected Growth in Medicare and Medicaid as Percent of GDP Source: Congressional Budget Office, Projected Federal Spending Under One Fiscal Scenario (Percentage of gross domestic product)
  14. 14. II . Why the U.S. Has Yet to Enact Universal Coverage <ul><li>Difficulty of making major reforms in the American governmental system </li></ul><ul><li>Universal coverage requires substantial income redistribution </li></ul><ul><li>Powerful interest groups </li></ul><ul><li>Dueling ideologies </li></ul><ul><ul><li>Fear of too much government control </li></ul></ul><ul><ul><li>Competition vs. regulation </li></ul></ul>
  15. 15. Health Reform Requires Imposing Limits <ul><li>Americans have historically resisted prior attempts to impose limits </li></ul><ul><li>Coverage costs more given American resistance to setting limits: </li></ul><ul><ul><li>Planning and capacity controls </li></ul></ul><ul><ul><li>State rate regulation </li></ul></ul><ul><ul><li>Managed care plans with restricted access </li></ul></ul><ul><ul><li>Comparative effectiveness research? </li></ul></ul>
  16. 16. Prior Justifications For Not Enacting Major Coverage Expansion <ul><li>Need to have well-regulated/managed system before introduce new demand </li></ul><ul><li>Before expanding coverage – especially entitlement to coverage – first must get health costs under control </li></ul><ul><li>The numbers of uninsured are exaggerated </li></ul><ul><li>The uninsured don’t work </li></ul><ul><li>The uninsured get care anyway </li></ul>
  17. 17. Prior Justifications… <ul><li>There are no major health consequences from being uninsured </li></ul><ul><li>Before enacting new national reform, first need to demonstrate the extent problem can be addressed via voluntary approaches </li></ul><ul><li>Cannot enact major new coverage expansion while facing a significant budget deficit </li></ul><ul><li>Why dramatically change a system that works for most Americans just to fix the “uninsured problem?” </li></ul>
  18. 18. III. How the U.S. Compares Internationally <ul><li>The comparative data presented in this segment on quality and cost demonstrates that the US could cover all its residents and provide higher quality at a lower cost to government, employers, and individuals </li></ul><ul><li>Not necessary to adopt a government run or single payer system like England, Canada, France or Japan </li></ul><ul><li>Could achieve better outcomes at lower cost through some combination of employer requirement and individual mandate that offers coverage through competitive private health plans such as is done in Germany, Netherlands or Switzerland </li></ul>
  19. 19. Infant Mortality Rate National Average and State Distribution International Comparison, 2004 Infant deaths per 1,000 live births ^ Denotes baseline year. Data: National and state—National Vital Statistics System, Linked Birth and Infant Death Data (AHRQ 2003, 2004, 2005, 2006, 2007a); international comparison—OECD Health Data 2007, Version 10/2007. Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008
  20. 20. Mortality Amenable to Health Care Deaths per 100,000 population* Data: E. Nolte and C.M. McKee, &quot;Measuring the Health of Nations: Updating an Earlier Analysis,&quot; Health Affairs Jan.-Feb. 2008, 27(1):58-71 analysis of World Health Organization mortality files. Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008. * Countries’ age-standardized death rates before age 75, including ischemic heart disease, diabetes, stroke, and bacterial infections.
  21. 21. International Health Expenditures Per Capita, 1980-2005 Data: OECD Health Data 2009 (June 2009)
  22. 22. Percentage of NHE Spent on Health Administration and Insurance, 2003 *Includes claims administration, underwriting, marketing, profits and other administrative costs. Data : OECD Health Data 2005 Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 Net costs of health administration and health insurance as percent of national health expenditures a a 2002 b 1999 b c 2001 c *
  23. 23. IV . What Will We Do This Time? <ul><li>The cost of doing nothing is staggering </li></ul><ul><li>Considerable areas of agreement but we could again let our ideological battle prevent us from enacting needed reforms </li></ul><ul><li>No pain, no gain. Cannot cover everyone without either raising taxes or making cuts in existing programs </li></ul><ul><li>Predict legislation will be signed by the President that will make a meaningful start on increasing coverage and “bending the cost curve.” Further reforms will be needed in the years ahead to obtain additional quality improvements and cost savings. </li></ul>
  24. 24. Cost of Inaction Over the Next Decade (2009-2019) <ul><li>Number of uninsured Americans will rise to between 57 and 65 million </li></ul><ul><li>Number lacking health insurance will grow by 10% in every state </li></ul><ul><li>Businesses will see premiums increase from 60-100% </li></ul><ul><li>More employers will drop employer-sponsored group insurance </li></ul><ul><li>States will be forced to spend much more on Medicaid, Children’s Health Insurance Programs (CHIP), and safety net services </li></ul><ul><li>“ Under any scenario, the analysis shows a tremendous economic strain on individuals and businesses in all states if reform is not enacted.” </li></ul>Source: Garrett B et al. “The Cost of Failure to Enact Health Reform: Implications for States.” Robert Wood Johnson Foundation, 2009.
  25. 25. State of Play for Congressional Proposals (As of December 1, 2009) Source: Congressional Budget Office Net Change in Deficit Over 10 years Net Change in # Uninsured Over 10 years Senate Leadership -$130 billion -31 million House Leadership -$109 billion -36 million
  26. 27. Prevention and Wellness Provision Senate Bill House Bill Preventive services Plans must provide coverage, without cost-sharing for preventive services and immunizations No cost-sharing for preventive services, as defined by HHS Prevention and wellness trust Authorizes up to $12.9 billion from FY 2010-2014 for Prevention and Public Health Fund Authorizes up to $15.4 billion from FY 2011-2015 for the Prevention and Wellness Trust Fund Focus on prevention -Creates the National Prevention, Health Promotion, and Public Health Council to establish and implement a national prevention and health promotion strategy -Invests in programs at the federal, state, and local level to increase access to clinical preventive services -Creates a national prevention and wellness strategy to improve the nation’s health through evidence-based clinical and community-based prevention Focus on wellness Creates a 10-state pilot project that tests the impact of providing wellness programs to at-risk communities Focus on community prevention and wellness services
  27. 28. Lessons from Implementing State Health Reform <ul><li>Reform is an evolutionary process </li></ul><ul><ul><li>Massachusetts did not pass comprehensive reform until its third attempt. Incremental and failed attempts can lay the groundwork for future efforts </li></ul></ul><ul><ul><li>New Jersey, Iowa, and Wisconsin are taking a phased approach. Policymakers are developing multi-year plans, enacting building block reforms, and planning to pass additional reforms in subsequent years </li></ul></ul><ul><li>Coverage expansions must be accompanied by value-enhancing strategies that contain costs and improve quality </li></ul><ul><li>Reform proposals can succeed or fail in the implementation process </li></ul><ul><ul><li>Key stakeholders are needed during implementation to ensure reform is successful </li></ul></ul><ul><ul><li>Programs must have simple, understandable rules. </li></ul></ul><ul><ul><li>Outreach and education are critical. </li></ul></ul><ul><li>Maintaining sufficient and sustainable funding for reform is essential </li></ul><ul><li>Need effective evaluation mechanisms to allow policymakers to adapt programs as needed </li></ul>
  28. 29. <ul><li>Health Safety Net (HSN) total volume for hospitals and community health centers increased by 2% in the first six months of Health Safety Net fiscal year 2009 (HSN09) compared to the same period in the prior year. </li></ul><ul><li>HSN payments for hospitals and community health centers increased by 0.4% in the first six months of HSN09 compared to the same period in the prior year. </li></ul>Massachusetts Division of Health Care Finance and Policy Health Safety Net Total Volume and Payments 783 K 486 K 494 K $331 M $195 M $196 M -38% +2% -41% +0.4% Volume Payments Source: DHCFP, Health Safety Net Data Warehouse as of 4/9/09 Note : The Uncompensated Care Pool fiscal year (PFY) and the Health Safety Net fiscal year (HSN) run from Oct 1 through Sept 30 of the following year.
  29. 30. Need to Get Started Now! <ul><li>Unrealistic to make all needed reforms at once </li></ul><ul><li>Incremental + Vision = Sequential </li></ul><ul><li>Even if sequential: </li></ul><ul><ul><li>Need to make commitment now to provide universal coverage, recognizing may have to be phased in over time </li></ul></ul><ul><ul><li>Need framework so can make progress on: </li></ul></ul><ul><ul><ul><li>Payment reforms </li></ul></ul></ul><ul><ul><ul><li>System integration, including prevention and wellness </li></ul></ul></ul><ul><ul><ul><li>Use of HIT and CER </li></ul></ul></ul><ul><ul><ul><li>Increased capacity to provide primary care, medical home </li></ul></ul></ul>

×