We don’t have a functional competitive market in health care in the U.S. Consequently, many of the attributes of competitive markets that are beneficial in our lives are not present in health care. One significant negative externality of a dysfunctional market is an inability to discern quality. Consumerism is critical. Includes data and analysis from the 5TH ANNUAL HEALTHGRADES PATIENT SAFETY IN AMERICAN HOSPITALS STUDY – APRIL 2008

1. TTUHSC - EL PASO - 3RD ANNUAL OB/GYN SYMPOSIUM APRIL 18, 2008 DON MCDANIEL CAREY BUSINESS SCHOOL THE JOHNS HOPKINS UNIVERSITY THE ECONOMICS OF QUALITY IN HEALTH CARE

8. TOTAL NATIONAL HEALTH EXPENDITURES Source: American Hospital Association via the Centers for Medicare & Medicaid Services, Office of the Actuary. Data Released January 8, 2007

9. PERCENT CHANGE IN TOTAL NATIONAL HEALTH EXPENDITURES Source: American Hospital Association via the Centers for Medicare & Medicaid Services, Office of the Actuary. Data Released January 8, 2007

10. NATIONAL HEALTH EXPENDITURES AS A PERCENTAGE OF GROSS DOMESTIC PRODUCT Source: American Hospital Association via the Centers for Medicare & Medicaid Services, Office of the Actuary. Data Released January 8, 2007

11. PROJECTED EXPENDITURES THROUGH 2016 Source: American Hospital Association via the Centers for Medicare & Medicaid Services, Office of the Actuary. Data Released January 8, 2007

12. GROWTH IN MEDICARE SPENDING VS. PRIVATE HEALTH INSURANCE SPENDING Source: American Hospital Association via the Centers for Medicare & Medicaid Services, Office of the Actuary. Data Released January 8, 2007

13. ANNUAL CHANGE IN PREMIUMS Source: The Kaiser Family Foundation and Health Research and Educational Trust.

14. HOSPITAL PAYMENTS AND COSTS - MEDICARE, MEDICAID, AND OTHER GOVERNMENT Source: American Hospital Association Annual Survey data, 2005, for community hospitals.

15. NATIONAL SUPPLY AND DEMAND PROJECTIONS FOR FTE RNS Source: National Center For Health Workforce Analysis, Bureau of Health Professions, Health Resources and Services Administration, 2004. Shortage of over 1,000,000 nurses in 2020

22. April 10, 2008 EDITORIAL Quality Care at Bargain Prices “ This year’s (Dartmouth) atlas focuses on Medicare spending for patients in the last two years of life at the top five teaching hospitals, as ranked by U.S. News & World Report. The medical center at the University of California, Los Angeles, was the most extravagant, averaging some $93,000 per patient. Johns Hopkins, at $85,000, and Massachusetts General, at $78,000, came next. The Cleveland Clinic, at $55,000, and the Mayo Clinic, at $53,000, were far more cost-effective.”

28. Health Care is Global Comparison of Spending on Health, 1980–2004 Data: OECD Health Data 2005 and 2006. Average spending on health per capita ($US PPP) Total expenditures on health as percent of GDP Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.

29. The World IS Flat!