"U.S. Healthcare Reform"

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10/23/2009

Aaron Katz, MPH
Principal Lecturer of Global Health (adjunct) and Health Services

Published in: Economy & Finance, Business
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"U.S. Healthcare Reform"

  1. 1. !" # ! $ % & & & ' ( )* +
  2. 2. New Australia Canada Germany Zealand UK US OVERALL RANKING (2007) 3.5 5 2 3.5 1 6 Quality Care 4 6 2.5 2.5 1 5 Right Care 5 6 3 4 2 1 Safe Care 4 5 1 3 2 6 Coordinated Care 3 6 4 2 1 5 Patient-Centered Care 3 6 2 1 4 5 Access 3 5 1 2 4 6 Efficiency 4 5 3 2 1 6 Equity 2 5 4 3 1 6 Long, Healthy, and Productive Lives 1 3 2 4.5 4.5 6 Health Expenditures/cap, 2004 $2,876* $3,165 $3,005* $2,083 $2,546 $6,102 ! Source: Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care, The Commonwealth Fund, 2007.
  3. 3. ! ! " # $ % % &
  4. 4. ' ( ) European US Banks Banks $10 Billion African Governments
  5. 5. *+ " !, - . /
  6. 6. 0 ( 12 Population Health Care Spending United States United 5% States Rest of 39% the Rest of World the World 61% 95% Source: Organization for Economic Cooperation and Development, 2006
  7. 7. " & 3 !1 5 4 67- " ! 4 $ / 5 6 3 * 78 10% ,- 0 ./ 0 1- 20% - 30 2- / ,- 0 ./ 0 1- 20% - / 2,- 29 1 23 . ; < ; > - 3 :- 9 1 / 50% ? ! 3 -1 ;< - 3 :- 9 1 / =< Sources: Centers for Disease Control and Prevention, University of California at San Francisco, Institute for the Future. Reprinted from Advances: The Robert Wood Johnson Foundation Quarterly Newsletter, 2000, Issue 1, supplement, page 1
  8. 8. - $ !8 ! ( 5 9 !" " ! "" #$
  9. 9. 6 : ! 8 # 5 ; 3= > <<? <>7 = "!! 6 ! ( 6 3= 7 << < > = - ! ! !- ! 3= > <@7 !84 3= 7 <A + 3= 7 <= =
  10. 10. = " B 5
  11. 11. ( 6 - C ( 5 1( 0 : "? 0 ! !B !6! ! - ! ! 45 ( ! D 5 ) E :0 ( D ; 8; ; 37
  12. 12. ( 6 - C ( 5 37 0 ! !B ( 5 D : F* ? 5, ( 45 D : F >E 1 5 ! D : ( D : ! " F 5 5 6 D 1 (F 0 ! G ! ? !
  13. 13. 0 ) ! @ /! A "!
  14. 14. - G<B Washingtonians in Families with High Health Care Costs Percent Share of pre-tax income on health 2000 2008 Insured care (2008) 923,000 1,333,000 > 10% (17.5%) (23.6%) 84.4% 254,000 386,000 > 25% 78.5% (4.8%) (6.8%) Source: Too Great a Burden: Washington’s Families at Risk, Families USA, December 2007
  15. 15. ( : 6 9 <> ! 2003 2008 2015 2020 $30,000 26,730 $25,000 23,842 21,009 19,731 $20,000 17,599 15,508 $15,000 13,788 12,298 10,837 10,748 9,249 $10,000 7,866 $5,000 1 $0 U.S. average Lowest state Highest state
  16. 16. - G B Capacity and Use Rates for Selected OECD Countries, 1999/2000 Acute Admissions Average Acute beds per per 1000 length of hospital 1000 pop pop hospital days per stay (days) capita Canada 3.3 99 7.1 1.0 France 4.2 204 5.5 1.1 Germany 6.4 205 9.6 1.9 Switzerland 4.1 136 9.3 1.3 US 3.0 118 5.9 0.7 Source: Anderson, GF, et al., Health Affairs, May/June 2003
  17. 17. - G B % ( < < ; < & < * + < * < & * < Spending & < < per capita * < as % of US = < < < ( < < A 0 4 " B Source: Organization for Economic Cooperation and Development, 2006
  18. 18. - ! 5 ! !( 6 ( 3 + 7< A ? = A 25% Medicare 20% Private Health Insurance Premiums 15% 10% 5% 0% 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 00 02 04 06 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 20 20 20 20
  19. 19. 15 !! + 4 6 : Coverage with skilled birth attendance in poorest quintile by type of provider, according to overall level of skilled birth attendance (%) All countries with DHS surveys analyzed by WB PHN 70 65 60 50 Percentage of births (%) 40 30 23 20 13 10 4 2 3 4 0 0 <10% 10-19.9% 20-39.9% 40-100% (% )Births attended by public providers (% )Births attended by private providers
  20. 20. & ; 6 0 15 4 ( ( + ( ; - " ) + 6 & 6 ;; & 6 ; + 6 + : !4 ;6 ( 6 * ( 6 ( 6 + /4 4 +( 6 +6 ;= 6 &= 6 ! 4 ( 6 ( ( 6 (* ( 6 6 Source: 1993, 1997 RWJF Washington Family Health Insurance Survey; 1998, 2000 Washington State Population Survey.
  21. 21. - & 3 7 $ % % ) Gov Public Investment Health 7% 3% Hospital 21% Prof Services All Admin 19% 36% NH/ HH Rx + 6% Products 9% Source: Rough calculations based on CMS 2007 reports and estimates of administrative expenditures by UW Health Policy Analysis Program, 1990
  22. 22. 6 ( & 11 10 9 (constant 1995 prices) E & ( 8 7 as a % of GDP 6 5 4 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 00 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 20 Source: Everhart and Sumlinski Simple average Weighted average From: Fiscal Space for Public Investment, UNDP, Sept 2006
  23. 23. " ( 8 ;$ ! ; - $ % % 5 ! 2004 46% 44% 10% Private 2000 57% 43% Public 1980 60% 40% Tax subsidy 1960 79% 21% 0% 20% 40% 60% 80% 100% Source: US Department of Health and Human Services, 2006; Katz estimate
  24. 24. + $ %! % 6 - - ! " US UK 1995 Spain Japan 1990 Canada Australia 0 50 00 50 00 50 00 50 00 50 00 50 00 50 00 50 00 2 5 7 10 12 15 17 20 22 25 27 30 32 35 37 40 MRIs / Million Population Source: Organization for Economic Cooperation and Development, 1999
  25. 25. - G)B " # " $ " $" % % A 9! 1 " & % THE WALL STREET JOURNAL September 21, 2009
  26. 26. ( H 5 ! ! # '1 # $ % & ' () * +, $- . . !
  27. 27. '%() *B 5 ! ! 5 ! ! 1986 2006 Health Public Health Public Care and Schools Care and Schools All Other 39.5% 45.7% All Other 38.4% 49.9% Higher Higher Ed Ed 10.6% 15.8% Source: Washington State Office of Financial Management, 2008
  28. 28. - G> + B " % The Impact of Quality-Reporting Programs on Hospital Operations September/October 2006 Health Affairs, Vol. 25, No. 5
  29. 29. Health Care Market Trends and the Evolution of Hospitalist Use and Roles February 2005 Journal of General Internal Medicine, Vol. 20, Issue No. 1
  30. 30. Health Benefits in 2005: Premium Increases Slow Down, Coverage Continues to Erode The Average Cost of Family Coverage Now Exceeds the Average Yearly Income of Minimum-Wage Americans September/October 2005 Health Affairs, Vol. 24, No. 5
  31. 31. ! B( - 0 ! 5 0 ! : ?- # 3 6 8 <) 97 *, % % $ % % , * Kaiser Daily Health Policy Report, November 14, 2008
  32. 32. I ; + 5 6 6 6 J 6 ? ! ! K 6 L 5 F 5 ! $ % % M 55 6 3 5 ! ! 7
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  34. 34. " H M ? ? '( 1 ; !I ! ! = << - ! <>

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