6. Health Care Spending per Capita in 2004 (Adjusted for Differences in the Cost of Living) Page Source: OECD Health Data Published in Health Affairs, Volume 26:5 2007
10. Premium Increases Compared to Other Indicators, 1988-2007 Page Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2006; KPMG Survey of Employer-Sponsored Health Benefits: 1988, 1993, 1996, 1998; Bureau of Labor Statistics, 2000. ^
16. Consumer Use of Quality Ratings Remains Low Page Considered a change based on these ratings Seen information that rates ... Actually made a change Physicians Health Plans Hospitals Source: Harris Interactive, Strategic Health Perspectives 2001-2006 13% 2% <1% 2001 15% 1% 1% 2006 18% 4% <1% 2001 23% 4% 1% 2006 22% 4% 2% 2001 21% 3% 1% 2006
17. Page Primary Care Practices With Advanced Information Capacity * Count of 14: EMR, EMR access other doctors, outside office, patient; routine use electronic ordering tests, prescriptions, access test results, access hospital records; computer for reminders, Rx alerts, prompt tests results; easy to list diagnosis, medications, patients due for care. Percent reporting seven or more out of 14 functions* Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
18. Page Capacity to Generate List of Patients by Diagnosis Percent reporting very difficult or cannot generate Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
19. Page Percent reporting any financial incentive* Primary Care Doctors’ Reports of any Financial Incentives Targeted on Quality of Care * Receive or have potential to receive payment for: clinical care targets, high patient ratings, managing chronic disease/complex needs, preventive care or QI activities. Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
20.
21.
22. Republican and Democratic Attitudes about Who Has the Best Health Care System Debating Health: Election 2008, Harvard School of Public Health/Harris Interactive. March 5-8, 2008
23. Republican and Democratic Beliefs about the State of Healthcare NEJM, “Health Care in the 2008 Presidential Primaries,” January 2008.
24.
25.
26. Page Source: Harris Interactive, Strategic Health Perspectives 2007 N=20* Pacific Business Group on Health, July 2007 Retreat % Answering Describes My Company Well
27. Page Source: Harris Interactive, Strategic Health Perspectives 2007 N=20* Pacific Business Group on Health, July 2007 Retreat % Answering Describes My Company Well
28. Page Physician Satisfaction with Current Practice Situation % Satisfied % Dissatisfied Source: Harris Interactive, Strategic Health Perspectives 1995-2007
32. Payment to Cost Ratio (Illustrative) Page Source: Morrison Estimates, in other words a good guess
33. Payment to Cost Ratio (Illustrative) Page Source: Morrison Estimates, in other words a good guess Single Payer Schwarzenegger
34.
35. Features of Building Blocks + System Reform and Presidential Candidates’ Approaches to Health Care Reform Source: S. R. Collins and J. L. Kriss, Envisioning the Future: The 2008 Presidential Candidates’ Health Reform Proposals , The Commonwealth Fund, January 2008. Building Blocks/ System Reform Clinton Republican Obama Coverage Expansion Aims to cover everyone X X X Individual requirement to have insurance X X Children only Employer shared responsibility X X X Group insurance “connector” X X X Medicare/public plan option for < 65 X X X Subsidies/tax credits for low- to moderate income families X X X X Regulation of insurance markets X X X Improves Medicare benefits for > 65 and buy-in for older adults X Medicaid/SCHIP expansion X X X System Improvements Expanded use of Health IT X X X X Medical effectiveness research X X X X Pay providers for performance X X X X Reduced Medicare Advantage payments X X X Negotiated Medicare Rx prices X X X Primary care and care coordination X X X X
36. Reputation of Pharma and Other Healthcare Industries was Improving after declines in 1990s *Condensed list of industries. (1) *In 1997 “computer companies” were rated together (i.e., hardware and software companies were not measured separately). (2) The trends for airlines are from 1998, as they were not included in the 1997 survey. N/A= Not Asked . Source: Harris Poll #79, August 8, 2007. Do you think each of the following generally do a good or bad job of serving their consumers? % Point difference between those indicating good vs. bad 2000 2001 2002 2003 2004 2005 2006 2007 1997-2007 2006-2007 Supermarket N/A N/A N/A 74 79 84 83 84 N/A +1 Computer software companies 71 72 48 57 62 67 67 61 -10 -6 Online search engines N/A N/A N/A N/A N/A 68 67 77 N/A +10 Computer hardware companies 70 71 49 57 64 74 64 64 -7 0 Banks 49 46 54 50 52 57 61 56 +4 -5 Packaged food companies N/A N/A N/A 58 62 67 59 55 N/A -4 Hospitals 48 41 56 53 49 59 51 58 +1 +7 Life insurance companies 39 36 34 29 27 44 42 18 -17 -24 Airlines 45 15 47 40 61 62 42 26 -40 -16 Telephone companies 32 27 22 20 17 42 38 35 -26 -3 Car manufacturers 40 40 41 38 44 34 31 46 +2 +15 Pharmaceutical and drug companies 24 20 30 4 -4 13 25 21 -39 -4 Managed care companies such as HMO -27 -30 -12 -23 -23 -13 -3 -20 -33 -17 Health insurance companies -15 -19 13 -12 -20 -19 -3 -21 -34 -18 Oil companies -13 -39 -6 -6 -25 -36 -24 -33 -57 -9 Tobacco companies -34 -37 -36 -32 -30 -28 -25 -46 -18 -21
37. Reputation of Pharma and Health Insurance Industries was Improving after big declines in the 1990s Do you think each of the following generally do a good or bad job of serving their consumers? % Point difference between those indicating good vs. bad Pharmaceutical and drug companies Managed care companies such as HMOs Health insurance companies Source: Harris Poll #79, August 8, 2007. Hospitals
44. SOURCE: Ellis JJ. J Gen Intern Med 2004;19:639-646. $0 to <$10 Compliance with Statin Therapy Stratified by Mean Prescription Copayment $10 to <$20 >$20
45. Reported Total Savings and Investments by Amount and Age Group SOURCE: 2007 Retirement Confidence Survey – EBRI NET WORTH All Workers Ages 25-34 Ages 35-44 Ages 45-54 Ages 55+ All Retirees <$10,000 35% 50% 36% 24% 26% 32% $10,000-$24,999 10% 18% 16% 10% 5% 13% $25,000-$49,999 13% 9% 10% 11% 9% 10% $50,000-$99,999 8% 10% 14% 15% 11% 12% $100,000-$149,999 7% 7% 7% 9% 11% 8% $150,000-$249,999 7% 1% 9% 10% 9% 12% $250,000-$499,999 7% 1% 4% 12% 11% 5% >$500,000 7% 4% 4% 9% 17% 9%
46.
47.
48.
49.
Editor's Notes
Health care cost is one benchmark against which both employers and employees measure health care. By that measure, with costs nearly doubling over the last five years, we should be getting more and better health care. While it’s true that there have been important advances in technology and new services, it is also sadly true that there is a huge value disconnect in our health care system . This Slide summarizes research done by RAND which found that American’s likelihood of getting the right care at the right time was about 50 percent. This landmark RAND study reveals substantial gaps between what clinicians know works and the care actually provided. These deficits persist despite initiatives by both the federal government and private health care delivery systems to improve care. Key findings: Overall, adults received about 55 percent of recommended care; The level of performance was similar for chronic, acute, and preventive care; Underuse of care was a greater problem than overuse. For example, patients failed to receive recommended care about 46 percent of the time, compared with 11 percent of the time when they received care that was not recommended and potentially harmful; Quality of care varied substantially across conditions. For example, people with cataracts received about 79 percent of recommended care; those with hip fractures received about 23 percent. Does Poor Quality Matter? The deficits in care documented by this study and others translate into thousands of preventable complications and deaths per year and billions of dollars wasted. People with diabetes received only 45 percent of the care they needed. Poor control of blood sugar can lead to kidney failure, blindness, and amputation of limbs. Patients with hypertension received less than 65 percent of recommended care. Poor blood pressure control is associated with increased risk for heart disease, stroke, and death. In fact, poor blood pressure control contributes to more than 68,000 preventable deaths annually. People with coronary artery disease received 68 percent of recommended care, but just 45 percent of heart attack patients received beta blockers and 61 percent got aspirin – medications that could reduce their risk of death by more than 20 percent. Additional information: http://www.rand.org/publications/RB/RB9053-1/RB9053-1.pdf
The state of health care quality in the United States is accurately summed up in this quote by Mark Chassin, a preeminent health services researcher (read quote). Quality and cost should be correlated the other way around.
Continued low impact of ratings. They have virtually no impact on consumer behavior.
Heather, Can we make this a trend line graph. Here is the question text: “ Do you think each of the following generally do a good or bad job of serving their consumers?” Following are the notations for this data: Harris Poll #31, April 25, 2006 Notes: (1) *In 1997 “computer companies” were rated together (i.e., hardware and software companies were not measured separately). N/A= Not Asked (2) The trends for airlines are from 1998, as they were not included in the 1997 survey. Heather, Can we make this a trend line graph. Here is the question text: “ Do you think each of the following generally do a good or bad job of serving their consumers?” Following are the notations for this data: Harris Poll #31, April 25, 2006 Notes: (1) *In 1997 “computer companies” were rated together (i.e., hardware and software companies were not measured separately). N/A= Not Asked (2) The trends for airlines are from 1998, as they were not included in the 1997 survey.