BobbygHealthCarePolicyTalk1110
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My presentation slide deck for a talk to a Nevada healthcare management group.
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BobbygHealthCarePolicyTalk1110
- 1. Some thoughts on health care policy reform November, 2010 Bobby Gladd, M.A., HIT Project Coordinator, HealthInsight Regional Extension Center
- 2. The long-sought national goal • Universal access • Improved quality • Reduced cost Can we do all of these, at once? Or is that naïve?
- 3. The now-sought national goal
- 4. U.S. population and NHE data • 2010 U.S. National Health expenditure, ~$2.7 trillion (17% of GDP), • 2010 U.S. population, ~310,000,000 people, • ~$8,709 per capita!
- 5. U.S. population and NHE data November 9th, 2010 news item: “…employer health care costs for active employees are projected to rise 8.2% (after plan changes), to an average annual cost of $10,730 in 2011.” - Wall Street Journal MarketWatch
- 6. U.S. population and NHE data • 5 % of population consumes half of the NHE • 50% of the population spends next to nothing on health care in any given year (~$50/month or less) • The rest of us are somewhere in between (Source: AHRQ, 2006)
- 7. U.S. population data, continued • Of 310,000,000 gross population, • 40,000,000 people age 65+ • 154,000,000 civilian labor force • 14,800,000 civilian unemployed • 1,500,0000 active military • 2,000,000 incarcerated • 11,000,000 illegal immigrants
- 8. U.S. population data projections
- 9. Einer Elhauge, 1994 “Most knowledgeable observers believe we could today easily spend 100% of our GNP on health care without running out of services that would provide some positive health benefit to some patient.” - "Allocating Health Care Morally," pg 1459
- 10. Brent James, MD, MStat, 1994 "Delivering optimal healing/curative treatment today only serves to ironically assure that you will likely face an older, sicker and much more expensive-to-treat patient in the future, and we will inevitably continue to face serious ethical social choices that go far beyond the clinical." - opening session remarks, IHC HealthInsight QI training
- 11. Brent James, MD, MStat, 1994 “Every misspent dollar in the health care system is part of someone’s paycheck.” - opening session remarks, IHC HealthInsight QI training
- 12. NCQA 2010 report: quality vs. cost
- 13. NCQA 2010 report: quality vs. cost
- 14. NCQA 2010 report: quality vs. cost
- 15. NCQA 2010 report: quality vs. cost
- 16. 2000-2001, quality vs. cost, Medicare
- 17. 2000: Worldwide longevity vs. cost
- 18. OK, at this point, what, if anything, can we agree on, given the evidence? Significant disparities exist, with respect to • access to care; • per capita cost; • clinical outcomes (“quality”), • both within our country, and with respect to comparable industrialized nations. But, even if you agree with the foregoing, what can/should we rationally do to improve things?
- 19. What, if anything, can/should we do now? • Repeal “ObamaCare” • Further de-regulate the health care free market (perhaps including pushing HSAs) • Tort reform (to abate “defensive medicine”) • Begin to phase out “fee-for-service” in favor of PCMHs and ACOs • Move toward “Single Payer” (e.g, “Medicare for all,” essentially “Canadian Model”) (Note: these are not all mutually exclusive)
- 20. One viewpoint of late
- 21. What, if anything, can/should we do now?
- 22. What, if anything, can/should we do now? “To get to the point where all people have access to high-quality healthcare, affordably, we must focus our attention on how the healthcare delivery system determines costs and quality. Then we need to change that delivery model entirely…” - John Toussaint, MD, Roger Gerard, PhD, “On The Mend”
- 23. What, if anything, can/should we do now? ”…We do not mean to suggest, however, that the external environment of healthcare repayment systems, insurance coverage, and regulations does not need to be overhauled. It is a badly broken system requiring major surgery. But we are convinced that the healthcare debate needs to start from a deep understanding of how healthcare value is actually delivered…” - John Toussaint, MD, Roger Gerard, PhD, “On The Mend”
- 24. Thank you! Questions? Bobby Gladd, HealthInsight REC BGladd@healthinsight.org bobbyg@bgladd.com bgladd.blogspot.com regionalextensioncenter.blogspot.com www.bgladd.com
Editor's Notes
- I have been studying this issue professionally, and academically since 1993, as a caregiver since 1996, and most recently as an acute care patient (perhaps cite recent experience). Show of hands: how many people are concerned about the cost and quality of U.S. health care? What do we even mean by “quality”?
- This first came on my radar with the 1994 JAMA article advocating a single-payer system, during my first tenure with HealthInsight, where I served as a hospitalization outcomes analyst.
- My piece of the health care QI world now, health information technology, seen as a critical component of health care improvement.
- We spend nearly double per capita annually relative to comparable industrial nations, but even were we to cut it in half the expenditures would still be huge.
- Health care cost inflation is outpacing overall inflation by a factor of seven or so.
- The main reason we cannot achieve broad political consensus for comprehensive reform: the hugely skewed utilization distribution.
- Roughly HALF the population has to tote the NHE note via their taxes.
- A greying society. The rapidly increasing growth of the high utilization demographic
- Elhauge’s counter to the moral absolutism position regarding health care as a dispositive, preeminent “right.”
- The health care delivery conundrum.
- A LOT of people are perfectly satisfied with the status quo.
- No correlation between cost and quality of outcomes.
- No correlation between cost and quality of outcomes.
- No correlation between cost and quality of outcomes.
- No correlation between cost and quality of outcomes. But, what is it about the upper left quadrant?
- Under Medicare, it seems that the more you spend, the worse the outcomes. The Fee For Service problem, among other factors.
- Take out the U.S. and Cuba “outliers” and the correlation weakens greatly, almost nli.
- Maybe you disagree with the “data.” Or, even if you do to whatever degree, what would constitute “improvement” to you?
- We need to honestly address the actuarial model vs social insurance model.
- The unreflectively angry populist protest contingent.
- Lean delivery. Mine the processes for QI and cost savings. The best book I have yet read on the topic of care delivery improvement.
- Lean delivery. Mine the processes for QI and cost savings
- Lean delivery. Mine the processes for QI and cost savings, while recognizing that other apsects of the “system” still need significant reform.
- Q&A?