California spends a lot on health care to treat its residents, but relatively little to ensure they are healthy, according to a new report. In 2018, for every $1 that California spent on health care services, it spent just $0.68 on other aspects of health, including social and public health services. That “other” figure is down by nearly half — from $1.22 — since 2007. While California’s total health care spending has grown nearly 150% since that year, spending on other services grew by around 40%. The report’s authors say that the state could rein in some of its $119 billion budget by cutting back on wasted costs, including unnecessary medical services. But it could also invest in community aspects of care tied to improved health, including raising the minimum wage and investing in public health, education, and other social programs.
Healthcare oligopoly is Affecting u.s. economy convertedRoyJMeidinger
The document provides an overview of rising healthcare costs and declining outcomes in the United States compared to other developed nations. It notes that while the US spends much more per capita on healthcare, it has lower life expectancy and rates of preventable deaths than peers. The high costs are driven by administrative waste, high prices, and lack of cost control. The document argues that healthcare costs are a major burden on the US economy and individuals, and that reforms are needed to reduce costs while improving access and outcomes for all Americans.
This document discusses Pinellas County, Florida. It provides background on when the county was founded and describes its population growth over time. The document then analyzes strengths and weaknesses in Pinellas County's health based on data from the U.S. Census Bureau and Healthy People 2020 objectives. Specifically, the document finds strengths in access to healthcare, preventative vaccines, and oral health but weaknesses in nutritional health, cholesterol awareness, and rates of cardiovascular disease. The focus then narrows to reducing cerebrovascular and cardiovascular emboli through prevention strategies.
Burnett County, Wisconsin faces several public health challenges including high rates of poverty, unemployment, and lack of access to healthcare. To address these issues, stakeholders have implemented the Healthy Burnett initiative as part of the state's Healthiest Wisconsin 2020 plan. This paper analyzes epidemiological data on Burnett County's demographics, economy, and health outcomes to identify priority areas for public health interventions. The data shows high rates of poverty, low educational attainment, and mental health issues. As a result, the county's public health programs focus on decreasing stigma and improving access to mental healthcare through initiatives targeting individuals, communities, and systems.
A comprehensive health care system that provides both health care coverage and public health programs is needed to help California's children and families stay healthy. While health care coverage for low-income children has expanded, budget cuts have undermined some public health services for children. Investing in preventive health programs can help more children grow up healthy and productive. Public health services have high returns through improved health and lower costs, so maintaining funding is important despite budget challenges. The future of children's health in California will depend on sustained support for both health care and preventive public health programs.
West Virginia has some of the highest smoking rates in the country, especially among pregnant women and youth. Raising the tobacco tax by $1 per pack could significantly improve public health and generate new tax revenue for the state. An increased tax would reduce smoking rates and the health costs associated with tobacco-related illnesses. It could also deter youth from starting to smoke and encourage pregnant smokers to quit. West Virginia currently has one of the lowest tobacco taxes in the nation, and a tax increase would make its rate more comparable to surrounding states. The additional tax revenue of over $600 million in 5 years could be invested in programs to benefit residents' health and well-being.
This document summarizes findings from tracking development assistance for health (DAH) globally. It discusses methods for estimating DAH from 1990-2010, key findings on trends in DAH and recipient government responses. It also outlines uncertainties in future global health financing due to economic conditions and priorities among donors. DAH has increased dramatically for HIV/AIDS, malaria and tuberculosis but less for maternal and child health and non-communicable diseases. On average, recipient governments decrease health spending by 43 cents to $1.14 for every dollar of DAH received. The outcome on future global health financing depends on donor priorities during fiscal contraction periods.
Universal Health Care in the United StatesShantanu Basu
The document discusses the current US healthcare system and theories of policy change. It analyzes how multiple problem streams, political conditions, and policy alternatives could converge to place healthcare reform on the policy agenda. Specifically, rising costs, decreased coverage, and poor outcomes have highlighted issues with the current system. Shifting public opinion and the upcoming presidential election may open a policy window to address universal healthcare.
Healthcare oligopoly is Affecting u.s. economy convertedRoyJMeidinger
The document provides an overview of rising healthcare costs and declining outcomes in the United States compared to other developed nations. It notes that while the US spends much more per capita on healthcare, it has lower life expectancy and rates of preventable deaths than peers. The high costs are driven by administrative waste, high prices, and lack of cost control. The document argues that healthcare costs are a major burden on the US economy and individuals, and that reforms are needed to reduce costs while improving access and outcomes for all Americans.
This document discusses Pinellas County, Florida. It provides background on when the county was founded and describes its population growth over time. The document then analyzes strengths and weaknesses in Pinellas County's health based on data from the U.S. Census Bureau and Healthy People 2020 objectives. Specifically, the document finds strengths in access to healthcare, preventative vaccines, and oral health but weaknesses in nutritional health, cholesterol awareness, and rates of cardiovascular disease. The focus then narrows to reducing cerebrovascular and cardiovascular emboli through prevention strategies.
Burnett County, Wisconsin faces several public health challenges including high rates of poverty, unemployment, and lack of access to healthcare. To address these issues, stakeholders have implemented the Healthy Burnett initiative as part of the state's Healthiest Wisconsin 2020 plan. This paper analyzes epidemiological data on Burnett County's demographics, economy, and health outcomes to identify priority areas for public health interventions. The data shows high rates of poverty, low educational attainment, and mental health issues. As a result, the county's public health programs focus on decreasing stigma and improving access to mental healthcare through initiatives targeting individuals, communities, and systems.
A comprehensive health care system that provides both health care coverage and public health programs is needed to help California's children and families stay healthy. While health care coverage for low-income children has expanded, budget cuts have undermined some public health services for children. Investing in preventive health programs can help more children grow up healthy and productive. Public health services have high returns through improved health and lower costs, so maintaining funding is important despite budget challenges. The future of children's health in California will depend on sustained support for both health care and preventive public health programs.
West Virginia has some of the highest smoking rates in the country, especially among pregnant women and youth. Raising the tobacco tax by $1 per pack could significantly improve public health and generate new tax revenue for the state. An increased tax would reduce smoking rates and the health costs associated with tobacco-related illnesses. It could also deter youth from starting to smoke and encourage pregnant smokers to quit. West Virginia currently has one of the lowest tobacco taxes in the nation, and a tax increase would make its rate more comparable to surrounding states. The additional tax revenue of over $600 million in 5 years could be invested in programs to benefit residents' health and well-being.
This document summarizes findings from tracking development assistance for health (DAH) globally. It discusses methods for estimating DAH from 1990-2010, key findings on trends in DAH and recipient government responses. It also outlines uncertainties in future global health financing due to economic conditions and priorities among donors. DAH has increased dramatically for HIV/AIDS, malaria and tuberculosis but less for maternal and child health and non-communicable diseases. On average, recipient governments decrease health spending by 43 cents to $1.14 for every dollar of DAH received. The outcome on future global health financing depends on donor priorities during fiscal contraction periods.
Universal Health Care in the United StatesShantanu Basu
The document discusses the current US healthcare system and theories of policy change. It analyzes how multiple problem streams, political conditions, and policy alternatives could converge to place healthcare reform on the policy agenda. Specifically, rising costs, decreased coverage, and poor outcomes have highlighted issues with the current system. Shifting public opinion and the upcoming presidential election may open a policy window to address universal healthcare.
This presentation discusses the history and key aspects of universal healthcare in the United States. It covers major healthcare programs and reforms over time like Medicare, Medicaid, and the Affordable Care Act. Key points of the ACA are explained, such as the individual mandate, health insurance exchanges, Medicaid expansion, and new regulations for insurance companies. The presentation also addresses criticisms around the cost of universal coverage and impacts on taxpayers, employers, and immigrants.
The document summarizes findings from a report that tracked global development assistance for health from 1990 to 2007. It found that development assistance for health nearly quadrupled over this period, fueled primarily by increases in funding for HIV/AIDS. New actors like the Global Fund and GAVI accounted for an increasing share of assistance. While disease burden and income levels influenced funding allocations, political and economic factors also appeared to play a role in determining which countries received assistance. The report aims to continue annually tracking development assistance to better inform global health policies and priorities.
The document discusses proposals in Congress to address the federal budget deficit that could negatively impact families living in poverty through cuts to important social programs. It provides examples of proposed cuts to Medicaid, SNAP food assistance, child nutrition programs, and more. Advocates argue these cuts would increase poverty and hunger. The document encourages readers to educate themselves and contact their representatives to urge alternative approaches that protect vulnerable populations.
Between 2013 and 2015:
- Uninsured rates for adults declined in all states, by at least 3 percentage points in 48 states. States that expanded Medicaid eligibility saw the largest declines of 10-13 percentage points.
- Uninsured rates among low-income adults also declined in every state. States that expanded Medicaid generally had lower uninsured rates among low-income adults.
- The share of children who were uninsured dropped by at least 2 percentage points in 28 states.
While access to coverage increased significantly nationwide due to the Affordable Care Act, some states still had high uninsured rates, especially for low-income populations. States that expanded Medicaid eligibility achieved greater reductions in uninsured individuals.
Health care policy in the United States, Canada and ChinaYuzhou Sun
This document compares the health care systems of the United States, Canada, and China. It finds that while the US spends the most on health care as a percentage of GDP, it has a lower life expectancy than Canada. China spends the least but has increased funding for reform. Key factors discussed include pharmaceutical costs, administration costs, income levels, the uninsured population, lifestyle/obesity rates, and recent reforms in the US and China. Excessive medical treatment and fraud are also noted as increasing costs without improving health outcomes.
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
This document discusses development assistance for health (DAH) and global health financing trends. It provides an overview of the Institute for Health Metrics and Evaluation's work tracking DAH from 1990-2010, including key findings on channels of assistance and top recipient countries. It also discusses trends in government health spending and the implications of economic uncertainty, including potential declines in DAH funding and increased focus on health program efficiency.
Will Healthcare Improve the US Economy in the Coming Years?anthonycasimano
With a double-digit growth rate, the healthcare industry is poised to improve the US economy. Also, looking at the current trend of growth, it does not seem like this is going to stop anytime soon. Healthcare has shown a healthy growth over the last decade between 2000 and 2010. Interestingly, healthcare employment grew by 25% while the employment rate dropped by more than 2% in the same period.
The document compares public and private health care systems around the world. It provides details on systems in countries like the UK, Mexico, Germany, Canada and the US. Public health care in Canada began in 1946 when Saskatchewan introduced free health care. Key acts in 1966 and 1984 further established Canada's national Medicare system. While Canada spends less per capita on health care than the US, it ranks higher in terms of quality and life expectancy.
The document summarizes the current state of universal health insurance in the United States. It discusses the fragmented nature of today's health care system and statistics on the uninsured. Research studies show that a universal single-payer system could cover all Americans for less money by reducing administrative costs. The document also briefly reviews universal health care systems in other countries like the UK, Germany, Japan, and Canada. It concludes by suggesting a universal system may be more achievable in the US than commonly believed.
Medicaid was established in 1965 under President Lyndon B. Johnson as a federal-state program to provide health coverage for low-income individuals and families. It has since expanded coverage to additional groups like children, pregnant women, the disabled, and the elderly. States administer their own Medicaid programs within federal minimum guidelines for eligibility and covered services. Both the federal and state governments jointly fund Medicaid, with the federal contribution varying by state based on per capita income. Over time, Medicaid has grown to cover over 60 million Americans and account for a significant portion of state budgets.
The document discusses health inequalities between ethnic groups. It notes that health issues are more serious for some ethnic minorities, especially blacks, who are more likely to experience poorer health outcomes and die younger than whites. Key factors that contribute to health differences include lifestyle, socioeconomic status, housing conditions, and rates of diseases such as heart disease, cancer, diabetes and hypertension. Overall, the document examines data showing inequalities in health statuses and top causes of death between ethnic groups in both the UK and US.
HCS 410(2) ACA Tittle IV-Prevention of Chronic diseasesMaria Jimenez
The document summarizes key aspects of the Affordable Care Act as it relates to prevention and wellness. It describes how the ACA aims to promote prevention, fund public health initiatives, and reduce chronic disease. It discusses provisions such as banning pre-existing condition exclusions, covering preventive services with no cost sharing, and investing in community-based prevention programs. However, it also notes that Republicans questioned whether these prevention initiatives were worth funding.
The document summarizes a presentation for the Montgomery County Health Department on the health needs of Burtonsville, MD. Three main health needs were identified: 1) lack of health insurance affecting 11.9% of residents, 2) poor air quality from ground-level ozone increasing chronic lung disease risks, and 3) young, black, and Hispanic mothers experiencing late or no prenatal care increasing risks of low birthweight infants. Recommendations include programs to enroll uninsured residents in health insurance, educate residents on air quality risks and prenatal care importance, and improve access to care.
Written by Adele Allison, National Director of Government Affairs, SuccessEHS.
The shape of the U.S. health care industry is changing every day, and this presentation sheds light on some interesting statistics including Primary Care Providers, The American Patient, Health Care and the U.S. Economy and more.
A Comparative Analysis Of The UK And US Health Care Systemsabbiemc
- Published a comparative review of health systems of the National Health Service in the United Kingdom and the varying approaches to health systems in the United States
- Developed research question, conducted interviews, utilized PubMed and similar research database systems, performed literature review, and prepared and submitted for publication
Healthcare causal essay sample from assignmentsupport.com essay writing ser...https://writeessayuk.com/
The document discusses challenges facing the US healthcare system as life expectancy increases and the population ages. Advancements in medicine have led to unprecedented growth in the elderly population. This will strain Medicare and increase demands for healthcare services, home care, and healthcare workers. It will also drive up overall healthcare expenditures. To support the growing elderly population, the government should promote education in health fields and encourage careers in geriatric, primary, and preventative care.
MPSA 2016 Poster: Low Wages and High Public Assistance Jamie Morgan, MPA
Low wages in Indiana have led to high rates of public assistance usage as workers struggle to afford basic needs. The state minimum wage of $7.25 per hour is not a living wage, yet it remains stagnant. Data shows that a large portion of public assistance recipients in Indiana have incomes from employment but still qualify for aid due to low earnings. Research found no correlation between political ideology or family structure and public assistance rates, but did find that higher rates of ALICE (Asset Limited, Income Constrained, Employed) residents were associated with greater public assistance enrollment. Raising the minimum wage could significantly reduce participation in aid programs by increasing earnings for working families.
The US spends more on healthcare than any other country, reaching $2.7 trillion in 2011 or $8,680 per person, while UK spending was 142.8 billion pounds or 9.4% of GDP. In the US, most receive insurance through employers or private purchase, while 31% use public insurance and 16% are uninsured. In contrast, UK citizens receive universal public healthcare through taxation. While the US spends more, it has lower life expectancy and poorer health outcomes than other wealthy nations, including the UK which was rated as having the most efficient and cost-effective system. The data shows clear differences between the privately-run US system and the government-run UK system.
Today it’s critical for providers to devote time to patient education; inform patients about their conditions and how to prevent, treat, and manage them. Proper management of chronic conditions extends well beyond episodic and infrequent visits to a provider’s office. This population health white paper discusses why patients must become responsible for their day-to-day disease management. Patients will frequently be required to self-monitor their health indicators, observe symptoms, and note behavior, but they must also adhere to complex medication regimens
Reforming of the u.s. health care system overviAKHIL969626
The U.S. needed health care reform because costs were too high and threatened to consume the entire federal budget. The Affordable Care Act aimed to make affordable health insurance available to more people by expanding Medicaid eligibility, creating state health insurance exchanges, prohibiting denial of coverage due to pre-existing conditions, increasing funding for community health centers, improving data collection on health disparities, and supporting community health workers. The health reform law significantly expanded access to affordable health coverage, especially important for Latinos who had higher uninsured rates compared to other groups.
The document summarizes the FY 2016 budget for the Department of Health and Human Services (HHS). Some key points:
- The budget totals $1.093 trillion in outlays, with 53% for Medicare, 32% for Medicaid, and 8% for discretionary programs.
- Funding priorities include expanding access to affordable health care, promoting science and innovation, protecting public health, and responsible stewardship of funds.
- The budget continues support for the Affordable Care Act by extending the Children's Health Insurance Program and improving coverage through programs like Medicaid, health centers, and the Indian Health Service.
This presentation discusses the history and key aspects of universal healthcare in the United States. It covers major healthcare programs and reforms over time like Medicare, Medicaid, and the Affordable Care Act. Key points of the ACA are explained, such as the individual mandate, health insurance exchanges, Medicaid expansion, and new regulations for insurance companies. The presentation also addresses criticisms around the cost of universal coverage and impacts on taxpayers, employers, and immigrants.
The document summarizes findings from a report that tracked global development assistance for health from 1990 to 2007. It found that development assistance for health nearly quadrupled over this period, fueled primarily by increases in funding for HIV/AIDS. New actors like the Global Fund and GAVI accounted for an increasing share of assistance. While disease burden and income levels influenced funding allocations, political and economic factors also appeared to play a role in determining which countries received assistance. The report aims to continue annually tracking development assistance to better inform global health policies and priorities.
The document discusses proposals in Congress to address the federal budget deficit that could negatively impact families living in poverty through cuts to important social programs. It provides examples of proposed cuts to Medicaid, SNAP food assistance, child nutrition programs, and more. Advocates argue these cuts would increase poverty and hunger. The document encourages readers to educate themselves and contact their representatives to urge alternative approaches that protect vulnerable populations.
Between 2013 and 2015:
- Uninsured rates for adults declined in all states, by at least 3 percentage points in 48 states. States that expanded Medicaid eligibility saw the largest declines of 10-13 percentage points.
- Uninsured rates among low-income adults also declined in every state. States that expanded Medicaid generally had lower uninsured rates among low-income adults.
- The share of children who were uninsured dropped by at least 2 percentage points in 28 states.
While access to coverage increased significantly nationwide due to the Affordable Care Act, some states still had high uninsured rates, especially for low-income populations. States that expanded Medicaid eligibility achieved greater reductions in uninsured individuals.
Health care policy in the United States, Canada and ChinaYuzhou Sun
This document compares the health care systems of the United States, Canada, and China. It finds that while the US spends the most on health care as a percentage of GDP, it has a lower life expectancy than Canada. China spends the least but has increased funding for reform. Key factors discussed include pharmaceutical costs, administration costs, income levels, the uninsured population, lifestyle/obesity rates, and recent reforms in the US and China. Excessive medical treatment and fraud are also noted as increasing costs without improving health outcomes.
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
This document discusses development assistance for health (DAH) and global health financing trends. It provides an overview of the Institute for Health Metrics and Evaluation's work tracking DAH from 1990-2010, including key findings on channels of assistance and top recipient countries. It also discusses trends in government health spending and the implications of economic uncertainty, including potential declines in DAH funding and increased focus on health program efficiency.
Will Healthcare Improve the US Economy in the Coming Years?anthonycasimano
With a double-digit growth rate, the healthcare industry is poised to improve the US economy. Also, looking at the current trend of growth, it does not seem like this is going to stop anytime soon. Healthcare has shown a healthy growth over the last decade between 2000 and 2010. Interestingly, healthcare employment grew by 25% while the employment rate dropped by more than 2% in the same period.
The document compares public and private health care systems around the world. It provides details on systems in countries like the UK, Mexico, Germany, Canada and the US. Public health care in Canada began in 1946 when Saskatchewan introduced free health care. Key acts in 1966 and 1984 further established Canada's national Medicare system. While Canada spends less per capita on health care than the US, it ranks higher in terms of quality and life expectancy.
The document summarizes the current state of universal health insurance in the United States. It discusses the fragmented nature of today's health care system and statistics on the uninsured. Research studies show that a universal single-payer system could cover all Americans for less money by reducing administrative costs. The document also briefly reviews universal health care systems in other countries like the UK, Germany, Japan, and Canada. It concludes by suggesting a universal system may be more achievable in the US than commonly believed.
Medicaid was established in 1965 under President Lyndon B. Johnson as a federal-state program to provide health coverage for low-income individuals and families. It has since expanded coverage to additional groups like children, pregnant women, the disabled, and the elderly. States administer their own Medicaid programs within federal minimum guidelines for eligibility and covered services. Both the federal and state governments jointly fund Medicaid, with the federal contribution varying by state based on per capita income. Over time, Medicaid has grown to cover over 60 million Americans and account for a significant portion of state budgets.
The document discusses health inequalities between ethnic groups. It notes that health issues are more serious for some ethnic minorities, especially blacks, who are more likely to experience poorer health outcomes and die younger than whites. Key factors that contribute to health differences include lifestyle, socioeconomic status, housing conditions, and rates of diseases such as heart disease, cancer, diabetes and hypertension. Overall, the document examines data showing inequalities in health statuses and top causes of death between ethnic groups in both the UK and US.
HCS 410(2) ACA Tittle IV-Prevention of Chronic diseasesMaria Jimenez
The document summarizes key aspects of the Affordable Care Act as it relates to prevention and wellness. It describes how the ACA aims to promote prevention, fund public health initiatives, and reduce chronic disease. It discusses provisions such as banning pre-existing condition exclusions, covering preventive services with no cost sharing, and investing in community-based prevention programs. However, it also notes that Republicans questioned whether these prevention initiatives were worth funding.
The document summarizes a presentation for the Montgomery County Health Department on the health needs of Burtonsville, MD. Three main health needs were identified: 1) lack of health insurance affecting 11.9% of residents, 2) poor air quality from ground-level ozone increasing chronic lung disease risks, and 3) young, black, and Hispanic mothers experiencing late or no prenatal care increasing risks of low birthweight infants. Recommendations include programs to enroll uninsured residents in health insurance, educate residents on air quality risks and prenatal care importance, and improve access to care.
Written by Adele Allison, National Director of Government Affairs, SuccessEHS.
The shape of the U.S. health care industry is changing every day, and this presentation sheds light on some interesting statistics including Primary Care Providers, The American Patient, Health Care and the U.S. Economy and more.
A Comparative Analysis Of The UK And US Health Care Systemsabbiemc
- Published a comparative review of health systems of the National Health Service in the United Kingdom and the varying approaches to health systems in the United States
- Developed research question, conducted interviews, utilized PubMed and similar research database systems, performed literature review, and prepared and submitted for publication
Healthcare causal essay sample from assignmentsupport.com essay writing ser...https://writeessayuk.com/
The document discusses challenges facing the US healthcare system as life expectancy increases and the population ages. Advancements in medicine have led to unprecedented growth in the elderly population. This will strain Medicare and increase demands for healthcare services, home care, and healthcare workers. It will also drive up overall healthcare expenditures. To support the growing elderly population, the government should promote education in health fields and encourage careers in geriatric, primary, and preventative care.
MPSA 2016 Poster: Low Wages and High Public Assistance Jamie Morgan, MPA
Low wages in Indiana have led to high rates of public assistance usage as workers struggle to afford basic needs. The state minimum wage of $7.25 per hour is not a living wage, yet it remains stagnant. Data shows that a large portion of public assistance recipients in Indiana have incomes from employment but still qualify for aid due to low earnings. Research found no correlation between political ideology or family structure and public assistance rates, but did find that higher rates of ALICE (Asset Limited, Income Constrained, Employed) residents were associated with greater public assistance enrollment. Raising the minimum wage could significantly reduce participation in aid programs by increasing earnings for working families.
The US spends more on healthcare than any other country, reaching $2.7 trillion in 2011 or $8,680 per person, while UK spending was 142.8 billion pounds or 9.4% of GDP. In the US, most receive insurance through employers or private purchase, while 31% use public insurance and 16% are uninsured. In contrast, UK citizens receive universal public healthcare through taxation. While the US spends more, it has lower life expectancy and poorer health outcomes than other wealthy nations, including the UK which was rated as having the most efficient and cost-effective system. The data shows clear differences between the privately-run US system and the government-run UK system.
Today it’s critical for providers to devote time to patient education; inform patients about their conditions and how to prevent, treat, and manage them. Proper management of chronic conditions extends well beyond episodic and infrequent visits to a provider’s office. This population health white paper discusses why patients must become responsible for their day-to-day disease management. Patients will frequently be required to self-monitor their health indicators, observe symptoms, and note behavior, but they must also adhere to complex medication regimens
Reforming of the u.s. health care system overviAKHIL969626
The U.S. needed health care reform because costs were too high and threatened to consume the entire federal budget. The Affordable Care Act aimed to make affordable health insurance available to more people by expanding Medicaid eligibility, creating state health insurance exchanges, prohibiting denial of coverage due to pre-existing conditions, increasing funding for community health centers, improving data collection on health disparities, and supporting community health workers. The health reform law significantly expanded access to affordable health coverage, especially important for Latinos who had higher uninsured rates compared to other groups.
The document summarizes the FY 2016 budget for the Department of Health and Human Services (HHS). Some key points:
- The budget totals $1.093 trillion in outlays, with 53% for Medicare, 32% for Medicaid, and 8% for discretionary programs.
- Funding priorities include expanding access to affordable health care, promoting science and innovation, protecting public health, and responsible stewardship of funds.
- The budget continues support for the Affordable Care Act by extending the Children's Health Insurance Program and improving coverage through programs like Medicaid, health centers, and the Indian Health Service.
Chapter 2Where Are WeAmerican health care is in a state of flJinElias52
Chapter 2
Where Are We?
American health care is in a state of flux as new scientific knowledge and clinical experience continue to change our definitions of illness and wellness. As a society, we respond by changing the ways health care is delivered. Health services increasingly impact our society—from health status to employment to budgetary economics to recreation to professional concerns to our perceptions of our own well-being.
American health care is also in flux because now that it has grown to more than one-sixth of our economy it threatens to squeeze out public goods such as education and infrastructure maintenance. People have wanted to do something about cost and access to care problems for a long time. The 2010 Affordable Care Act (ACA) is doing much to address access issues, but opposition to certain provisions is strong. Employers are steadily shifting more risk to employees and their families, and there is a real tension between Washington and the state capitols over Medicaid expansion. Medicare trust funds are forecast to disappear over the next decade or so. Washington is unlikely to tolerate another major health reform battle, although major changes may come as a side effect of a “grand” government overhaul of spending and tax policies. The future is highly uncertain, and still we must plan and act as we go along.
This chapter reviews the current status of the U.S. health care system from several points of view:
• Current outcomes and costs
• Quality
• Leadership
• Complexity
• Industrializing structures for delivery
• Medicalization of our society
• Redistribution of wealth
2.1 Current Outcomes and Costs
Previous section
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2.1 CURRENT OUTCOMES AND COSTS
Health care expenditures were projected to rise to close to 20% of the U.S. gross domestic product (GDP) by 2015 (Borger et al., 2006), but more recent estimates from the Centers for Medicare & Medicaid Services (CMS) project it to be 18.2% for 2015 and 19.5% by 2021 (CMS, 2012). Average annual family health insurance premiums were estimated for 2012 at $15,745, with $11,429 paid by employers. The 4% growth rate for 2012 was slow by historical standards but still more than twice the growth rate of wage income. The comparable total insurance cost for a single individual was $5,615. Large employers (98%) offered health care benefits to workers but were cutting back on retiree health benefits. Only 50% of firms with 3 to 9 workers and 73% with 10 to 24 workers offered health benefits. Many small companies do not provide health benefits. At the same time, control of health care by health professionals is being threatened by outsiders calling for more reliance on government programs, more consumer-centered care, or both.
High Comparative Costs and Low Comparative Outcomes
The United States spends far more on health care per capita and as a percentage of GDP than other developed countries, yet does not seem to be much better off for it. Table 2-1 illustrates this ...
This document discusses a data analysis task involving childhood obesity rates in different regions of the United States. The analysis will use data on the percentage of overweight and obese children ages 10-17 in each state. The states will be categorized into regions - East, South, Midwest, and West. A cluster analysis technique will be used to determine if there are trends in childhood obesity rates between different regions. If trends are found, government and healthcare organizations can focus obesity prevention programs on specific regions. The document provides background on the situation, data sources, and analysis methodology to be used.
The document discusses Medicare spending in the United States. It reports that Medicare spending was reduced to 0.2% in 2013 compared to 1.8% between 2009-2012. This decrease may have resulted from the recession limiting spending, delivery system reforms to improve quality while reducing local costs, or a focus on patient-centered care. Statistical data from Medicare budget reports is cited to support the claims around reduced spending.
The document provides an overview of treatment programs operated by the Ohio Department of Health (ODH) and analyzes how the Affordable Care Act and other changes have impacted these programs. It finds that some programs have seen decreased demand for services while others have increased. It identifies opportunities to better integrate ODH programs into the formal healthcare system to improve care, health outcomes, and lower costs. The report recommends ODH reassess its programs and consider using federal funding more flexibly and creatively to address the state's leading health issues.
You should respond to at least two of your peers by extending- refutin.docxjosee57
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts.
Post #1
Jenna Horgan
NUR 420
Professor Roberts
January 12, 2023
Who are the clients in Community Health nursing?
Individuals, families, and groups who live in a specific geographic area and may be at risk for health problems or in need of health services are considered clients in community health nursing. People of all ages, from infants to the elderly, as well as those with physical, mental, or social challenges, may be included. The purpose of community health nursing is to promote the health and well-being of the entire community by addressing the health needs of its individual members (Rector & Stanley, 2021). Community health nurses work with clients to identify and address health risks, provide health and wellness education, and connect clients to suitable health services.
What government resources might they be eligible for?
Individuals and families may be eligible for a variety of government resources depending on their circumstances. Some of these resources are intended specifically for people with low incomes or who are experiencing financial hardship, while others are open to anyone who meets certain criteria. Among the resources available to them are (ISPOR, n.d):
1. Medicaid: It is a federal-state partnership program that provides health insurance to low-income individuals and families. Individuals must meet income and asset limits, as well as other requirements, to be eligible.
2. Children's Health Insurance Program (CHIP): It is a federally funded program that provides health insurance to low-income children that are not eligible for Medicaid but cannot afford private health insurance. It provides coverage for a variety of medical services, such as preventive care, doctor visits, hospital stays, and prescription medications. Eligibility is determined by income and family size.
3. Supplemental Nutrition Assistance Program (SNAP): It is also known as food stamps and it provides financial assistance to low-income individuals and families in order for them to purchase food. Income and assets, as well as other factors, determine SNAP eligibility.
4. Temporary Assistance for Needy Families (TANF): This program helps low-income families with children by providing financial assistance as well as other services such as job training and childcare. Income and assets, as well as other factors, determine TANF eligibility.
5. Low Income Home Energy Assistance Program (LIHEAP): It is program funded by the federal government that provides low-income households with financial assistance to help them pay for home energy costs such as heating and cooling. The Department of Health and Human Services (HHS) administers the program, which is intended to assist households that are struggling to pay their energy bills and may face having their service disconnected. Eligibility is determined by income and family size.
What ag.
The macro trends in healthcare and the associated careershivani rana
This document discusses emerging macro trends in the US healthcare system and their impact on future healthcare jobs. It identifies trends like changes in the economy, demographics, lifestyles, technology and government policies. It notes that healthcare accounts for 18% of the US economy and that between 2010-2020 there will be over 5 million new healthcare jobs. It explores how trends like an aging population, increased chronic diseases, technology and policies like the Affordable Care Act are changing the system. Various career opportunities that may emerge like health economists, home healthcare workers, public health educators and health IT analysts are also outlined.
Running Headhead FEDERAL GOVERNMENT IN HEALTH CARE 1FEDERAL .docxanhlodge
Running Headhead: FEDERAL GOVERNMENT IN HEALTH CARE 1
FEDERAL GOVERNMENT IN HEALTH CARE 12
Federal Government in Health Care
Alexander Ludena
Saint Joseph’s University
Health Care Organization
HAD 553
Instructor: Dr. Charl Mattheus
12/10/2017
Abstract
The federal government plays an important role in influencing all facets of health care through its different roles in the American health care sector. This paper will discuss the involvement of the federal government in the health care system through its various roles and how that contributes to health care access, affordability, and quality. This includes its role in purchasing health care services, regulation of healthcare, provider of health care services, sponsor of learning and training programs and in health care research. Through its role as purchaser, the government is involved in buying health care insurance for millions of Americans. This is accomplished through programs including Medicare and Medicaid. In its role as regulator, the government is involved in establishing safety and quality standards aimed at ensuring that patients receive appropriate care. It is also involved in reforming healthcare to ensure it’s affordable, contains value and is accessible to all. This paper will also discuss the involvement of the federal government as provider of health services. As provider, the federal government is involved in the ownership and management of various health care institutions. At this particular capacity, it’s involved in employment of healthcare professionals and as operator of health care delivery systems. This paper will discuss how the federal government is involved in providing health care to diverse population through various federal agencies such as the VHA and the HIS. The federal government has a key role in shaping research in health care through its role as sponsor of applied health care services. It’ll be further discussed government involvement as it plays an imperative role in supporting the development of knowledge and creation of tools required to augment the government in carryings its various roles. This include government sponsorship of research through various agencies including the Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health (NIH).
Federal Government in Health Care
The provision of health care services to America’s diverse population represents one of the largest segments of the American economy. The federal government is involved in all aspects of the health care sector. Its role and mandate in the healthcare system areis defined by the constitution. It plays somea number of different roles in the American health care field, including the regulation of the medical industry, purchasing health care, health care services provision, sponsorship of education and training programs for health care professionals as well health care services research.
The federal government is majorly involved in healthcare .
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The document discusses rising healthcare costs in the US, especially for the aging population, and potential solutions. It notes that Medicare and Medicaid costs are unsustainable and many doctors do not accept those patients due to low reimbursement rates. Several solutions are proposed: 1) Reconsidering elder care options like home care instead of nursing homes could reduce costs while improving quality. 2) Using technology to deliver home-based care may improve financial outcomes. 3) Educating elders on healthy behaviors could reduce expensive chronic diseases. Overall, changes are needed to make elder care more efficient and reduce healthcare spending.
1 3Defining the ProblemRigina CochranMPA593August 1.docxsmithhedwards48727
1
3Defining the Problem
Rigina CochranMPA/593
August 19, 2019
Peter ReevesDefining the Problem
The health care system in Colorado is a composition of medical professionals providing services such as diagnosis, treatment, as well as preventive measures to mental illness and injuries ("Healthcare policy in Colorado - Ballotpedia," 2019). Health care policy involves the establishment and implementation of legislation and other regulations that the states use to manage its health care system effectively. Further, this sector consists of other participants, such as insurance and health information technology. The cost citizens pay for medical care and also the access to quality care influence the overall health care providers in Colorado. Therefore, the need for the creation and implementation of laws that help the state maintain efficiency in the health sector in Colorado.
Problem Statement
The declining standards of medical care within the United States has caused significant concern in the world. Due to these rising concerns, there have been various policies implemented, leading to mixed reactions among the different states. Some of the active policies implemented offer a long-term solution to this problem including Medicaid and Medicare. After acquiring state control, the Republicans dismissed the idea to expand and create medical insurance for Medicaid in Colorado. Sustaining the structure of the health care payroll calls for the deductions from the employees and the employers, which may lead to loss of jobs and increased burden of expenditure (Garcia, 2019).
Identify the Methodology
The main objective of this policy plan is to investigate the role of legislation in the management of the health care sector in the United States. Due to the need for achieving in-depth exploration, this paper uses a combination of both qualitative and quantitative methods of data collection by addressing both practical and theoretical aspects of the research. Based on the answers that the policy requires, choosing survey as the research design. This method involves collecting and analyzing data from a few people who represent the principal group within health care. However, the survey method faces some challenges such as attitudes and perception of the health workers leading to the delimitation of the study. The target population for the study includes the nurses within the health sectors in Colorado. The selection of the participants involved in the use of stratified random sampling.
Identify your Stakeholders
The major stakeholders in the creation and implementation of the policy plan include the legislatures, local government, patients, and other private parties such as the insurance companies. Collectively, these bodies are involved in the making of thousands of decisions, overseeing hospitals, making budgetary appropriations, assisting the health workers to acquire licenses, determination of services that the insurers cover, and the management of.
This document summarizes a journal article that examines the relationship between public expenditure and health status in Ghana. The main findings are:
1) The availability of physicians and health insurance are the most important determinants of health status in Ghana, as measured by under-five mortality rate.
2) Contrary to some previous studies, income per capita was found to be an insignificant determinant of health status in Ghana.
3) The results support increasing public investment in health, especially to train more physicians, as well as expanding Ghana's national health insurance program.
INFLUCENCE OF POLITICS ON HEALTH POLICIES OF INDIA 20-9.pptxsangeetachatterjee10
The document discusses the influence of politics on health policies in India. It outlines several domains of government's role in health development, including leadership and governance, health service delivery, health care financing, and human resource development. It also discusses India's public and private healthcare systems, noting positives like growing facilities but also challenges like uneven quality and rural-urban disparities. It concludes by recommending that governments prioritize health spending and strengthen core public health functions to improve health outcomes and access across India.
The document summarizes key points from a meeting of Advocates for Ohio's Future regarding the state budget. Key policy priorities discussed include preserving Medicaid eligibility and services, adequately funding programs for the elderly, food access, behavioral health, and early childhood education. Concerns were raised that the budget cuts funding for important social services and does not direct new revenue towards health and human services. Advocates were urged to contact state legislators and express that any new revenue should support programs for health, nutrition, and vulnerable groups.
The document summarizes key points from a meeting of Advocates for Ohio's Future regarding the state budget. Key issues discussed include inadequate funding for programs like Medicaid waivers, mental health services, food banks, and child nutrition. Speakers urged contacting legislators to prioritize additional revenue for health and human services programs.
The document discusses West Virginia's other post-employment benefits (OPEB) liability for retiree healthcare. It summarizes that while the costs are growing significantly, the liability is manageable rather than a crisis if put into proper context compared to budget and economic growth. Currently, retiree healthcare costs around $400 million annually but is projected to reach nearly $1 billion by 2025, though state budgets and GDP are also expected to grow considerably. The liability exists because the state has provided subsidized healthcare to retired public employees since the 1970s.
Running Head THE NEED FOR APPROACHES TO IMPROVE CAUSE ADMINISTRA.docxaryan532920
Running Head: THE NEED FOR APPROACHES TO IMPROVE CAUSE ADMINISTRATION AND REPAYMENT IN THE HEALTHCARE SYSTEM
1
THE NEED FOR APPROACHES TO IMPROVE CAUSE ADMINISTRATION AND REPAYMENT IN THE HEALTHCARE SYSTEM
10
Title: The Need for Approaches to Improve Case Administration and Repayment in the Healthcare System
Abstract
The medical care system of the United States of America for the past years has been considered to be the most expensive in the world. The government of the United States has to spend huge amounts of money for medical care in relation to the gross domestic product and these sums are systematically increasing. Now many scholars came to the conclusion that it is the government programs, which held the responsibility for the growth of uncontrolled spending on medical care, with which such growth is a threat to the financial stability of the United States. The issue is worth-discussing, thus, the given work is devoted to the overview of the structure and the main issues of the US healthcare system to find the effective solution.
Unlike other developed countries the medical care system in the United States of America demands more and more funds while its quality remains the same. 1/3 of the US citizens are still uninsured and there is no future hope for improving the situation. People suffer from rapidly growing prices of medical services and slow growth of salaries inclement. Furthermore, the department of insurance loses its integrity and honesty; since they use such an opportunity to fraud money as well as not paying the workers. The risk of becoming bankrupt is very high in medical care system because of unplanned budget. The insurance programs, financed by the state, are also becoming more expensive, and the government is forced to pay more and more money, which later brings about increase in state financial expenditure that immensely contribute to the poor economy. Employees do not have the free will to change their job due to the high cost of insurance and the monopolization (Stone, et al., 2008,p.2-57). This paper will provide evidences by giving the most effective solution to control this problem and also encouraging people make decisive market decisions by finding new approaches.
There are many ways of handling this subject issue of “The Need for Approaches to Improve Case Administration and Repayment in the Healthcare System,” but this research paper primarily will focus on the five articles that represent scholarly articles concerning the subject issue on this topic. The five scholarly articles are: Nolin, (2015) in his study about “Jail overcrowding a perennial issue for many counties; (Stone, P., Hughes, R., & Dailey, M. 2008)about “Creating a safe and high-quality health care environment: Agency for Healthcare Research and Quality (US); U.S. Department of Health & Human Services (2014). New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings; Unit ...
- Louisiana faces a $1.3 billion state budget shortfall for FY 2013-2014. The governor's budget proposes cuts to address this.
- The document advocates for expanding Medicaid in Louisiana under the Affordable Care Act, which would insure 400,000 people and inject $15.7 billion into the state economy by 2022. This would benefit safety net providers like community health centers.
- It supports several bills that would standardize Medicaid processes, increase transparency, integrate behavioral health services, and prohibit smoking near state buildings to improve public health.
This presentation discusses IHME's research in public financing of health in developing countries, including study design, findings, study limitations, and recommendations for governments and future research.
For more information please visit www.healthmetricsandevaluation.org
Similar to California pays a lot for health care, not so much for keeping people healthy (20)
The world stands to lose close to 10% of total economic value by mid-century if climate change stays on the currently-anticipated trajectory, and the Paris Agreement and 2050 net-zero emissions targets are not met.
Many emerging markets have most to gain if the world is able to rein in temperature gains. For example, action today to get back to the Paris temperature rise scenario would mean economies in southeast Asia could prevent around a quarter of the gross domestic product (GDP) loss by mid-century that they may otherwise suffer. Our analysis in this report is unique in explicitly simulating for the many uncertainties around the impacts of climate change. It shows that those economies most vulnerable to the potential physical risks of climate change stand to benefit most from keeping temperature rises in check. This includes some of the world's most dynamic emerging economies, the engines of global growth in the years to come. The message from the analysis is clear: no action on climate change is not an option.
Promise and peril: How artificial intelligence is transforming health careΔρ. Γιώργος K. Κασάπης
AI has enormous potential to improve the quality of health care, enable early diagnosis of diseases, and reduce costs. But if implemented incautiously, AI can exacerbate health disparities, endanger patient privacy, and perpetuate bias. STAT, with support from the Commonwealth Fund, explored these possibilities and pitfalls during the past year and a half, illuminating best practices while identifying concerns and regulatory gaps. This report includes many of the articles we published and summarizes our findings, as well as recommendations we heard from caregivers, health care executives, academic experts, patient advocates, and others.
In 2020, Amnesty International recorded the lowest number of executions in over a decade at 483. This was a 26% decrease from 2019. Four countries - Iran, Egypt, Iraq and Saudi Arabia - accounted for 88% of all recorded executions. The global number of known death sentences also decreased by 36% compared to 2019, partly due to disruptions from the Covid-19 pandemic. However, some countries like Egypt more than tripled their executions and the US resumed federal executions after a 17-year hiatus, putting 10 men to death over 5 months. Overall, the report found that the trend towards global abolition of the death penalty continued in 2020, but the pandemic exacerbated the cruelty of capital punishment in some retaining
Aviva’s first How We Live report was published in September 2020 when the world was firmly in the grip of a global pandemic. In the UK the vaccination programme is well underway and the mood of the nation is hopeful. This latest How We Live report looks at the long-term effects of the Coronavirus outbreak and considers its impact on our future behaviours.
We interviewed 4,000 adults across the UK to gather their views on a wide range of lifestyle decisions including property priorities, home-working, green living, career paths, vehicle choices and holiday plans. We also asked whether people had experienced any positive outcomes from the Covid pandemic. This report considers the practical and emotional skills which have been fostered as a result. Since the beginning of 2020, the UK has seen immense change. As we look forward to a sense of “normality” it remains to be seen which aspects of life will return to their previous states, and where we can expect changes to become permanent fixtures.
The life insurance industry provides protection against the financial consequences of the premature death of a family breadwinner, disability, or outliving one’s retirement assets. But how are life insurance products actually designed and priced?
Product committees comprising agents, underwriters, actuaries, and senior management sit and discuss what new products should be offered. The agents have vast experience visiting with policyholders to determine their needs. Underwriters set the guidelines on which policyholders will be accepted and/or rated. Smart actuaries (while most would find this redundant, some would call it an oxymoron) assess the potential risks in these products and set a potential price. Senior management listens to agents, underwriters, and actuaries and helps finalize the product design, the guidelines for accepting risks, and the price. The programmers will also have to be contacted to determine the cost of administering the products. Many iterations of these discussions may take place before a product is ready for sale. The entire process could take up to a year.
Some of these products are quite complex, taking into account long-term interest rates and probabilities of death/survival, disability, and lapse. With this lengthy and rigorous process, one would imagine that few mistakes are made. However, this is not the case. What follows are a few examples of major product mistakes which cost the life insurance industry a lot of time, money, and bad publicity.
The COVID-19 pandemic and subsequent lockdowns forced many insurers to accelerate the transition to digital business models. In many countries, this transition has been remarkably successful, however, the crisis also highlighted the critical role played by national regulatory frameworks in both hindering and facilitating the shift to digitalisation in the insurance industry. COVID-19 lockdowns highlighted the critical role of national regulatory frameworks in both hindering and facilitating the shift to digitalisation in the insurance industry. Digitalisation is not a goal in itself, but provides insurers and their customers with benefits that are particularly useful in situations where in-person interactions cannot take place, played out in its fullest form during the COVID-19-induced lockdowns. Digitalisation drives an increase in speed and efficiency, irrespective of where the customer is located, and promises improved customer service and satisfaction.
The document discusses the Internet of Things (IoT) and its implications for insurance. It notes that as more "things" become connected to the internet and collect data, this creates opportunities for new types of insurance products based on device interactions and data-driven risk assessments. However, it also raises issues around data integrity, privacy, security and regulation that must be addressed. The insurance industry could gain over $1 trillion in new premiums if it properly manages risks related to data, cybersecurity, cloud computing and more.
The rapid rise of online political campaigning has made most political financing regulations obsolete, putting transparency and accountability at risk. Seven in 10 countries worldwide do not have any specific limits on online spending on election campaigns, with six out of 10 not having any restrictions on online political advertising at all.
Highlights
• On average, concerns over Innovation was ranked highest, followed by Implications of Covid-19 • Respondents indicated innovation is important, but are mostly in process
• Respondents were mostly confident in implementing their innovation plans.
• Nearly half of respondents indicated their focus was on the customer experience • Most respondents expect some negative impact from Covid-19, with decreased profit indicated most, followed by decreased sales effectiveness, which are likely related
• The most common change in response to the Covid-19 impact were workplace and staffing changes, followed by technology investments
• Of the respondents, 92% indicated cyber security was important or very important.
• Continuous effort was ranked highest, and Mitigating internal threats, Identifying external threats, and Prioritizing identifying cyber risks were ranked next.
• While 95% of respondents indicated emerging threats were important or very important, 28% Indicated they were very good at responding to them
• For resiliency and sustainability, corporate ESG and R&S for internal operations were ranked as the highest priorities
iis the institutes innovation covid-19
What North America’s top finance executives are thinking - and doingΔρ. Γιώργος K. Κασάπης
Each quarter (since 2Q10), CFO Signals has tracked the thinking and actions of CFOs representing many of North America’s largest and most influential companies. All respondents are CFOs from the US, Canada, and Mexico, and the vast majority are from companies with more than $1 billion in annual revenue. The 1Q 2021 survey was open from February 8-19, 2021. A total of 128 CFOs participated, 69% from public companies and 31% from privately held companies.
Democratic watchdog organization Freedom House has released its annual ranking of the world's most free and most suppressed nations.
The report is a key barometer for global democracy and this year's edition found that global freedom has declined for the 15th straight year. 2020 was a turbulent year with the pandemic, violent conflict and economic and physical insecurity leading to democracy's defenders sustaining heavy losses against authoritarian foes which has resulted in a shift in the internatioal baance in favor of tyranny.
A total of 195 countries and 15 territories were analyzed on their levels of access to political rights and civil liberties with the number experiencing a deterioration in their freedom scores exceeding the number that saw improvement by the widest margin since 2006. In 2020, nearly 75 percent of the world's population lived under a government that saw its democracy score decline in the past year.
Women, Business and the Law 2021 is the seventh in a series of annual studies measuring the laws and regulations that affect women’s economic opportunity in 190 economies. Amidst a global pandemic that threatens progress toward gender equality, the report identifies barriers to women’s economic participation and encourages reform of discriminatory laws. This year, the study also includes important findings on government responses to the COVID-19 crisis and pilot research related to childcare and women’s access to justice.
Strong competition undoubtedly contributes to a country’s productivity and economic growth. The primary objective of a competition policy is to enhance consumer welfare by promoting competition and controlling practices that could restrict it. More competitive markets stimulate innovation and generally lead to lower prices for consumers, increased product variety and quality, more entry and enhanced investment. Overall, greater competition is expected to deliver higher levels of welfare and economic growth.
Long-erm Care and Health Care Insurance in OECD and Other CountriesΔρ. Γιώργος K. Κασάπης
This report carries out a stocktaking of what systems have in OECD and non-OECD countries for longterm care and health care, as well as the types of insurance products that are made available in these countries. It is part of a broader project that examines the complementarity of the social security network with the private insurance market, which examines how insurance could support the public sector longterm care and health care systems, as well as considering the financing of long-term care and health care.
This tenth edition of Global Insurance Market Trends provides an overview of market trends to better understand the overall performance and health of the insurance market. This monitoring report is compiled using data from the OECD Global Insurance Statistics (GIS) exercise. The OECD has collected and analysed data on insurance in OECD countries, such as the number of insurance companies and employees, insurance premiums and investments by insurance companies, dating back to the 1980s. Over time, the framework of this exercise has expanded and now includes key items of the balance sheet and income statement of direct insurers and reinsurers.
Does AI threaten and undermine human value in the workplace more than any other technology? There have been significant advances in AI, but will their impact really be different this time?
This literature review takes stock of what is known about the impact of artificial intelligence on the labour market, including the impact on employment and wages, how AI will transform jobs and skill needs, and the impact on the work environment. The purpose is to identify gaps in the evidence base and inform future research on AI and the labour market.
The OECD has estimated that 14% of jobs are at high risk of automation.
•Despite this, employment grew in nearly all OECD countries over the period 2012-2019.
•At the country level, a higher risk of automation was associated with higher employment growth over the period. This might be because automation promotes employment growth by increasing productivity, although other factors are also at play.
•At the occupational level, however, employment growth was much lower in occupations at high risk of automation (6%) than in occupations at low risk (18%).
•Low-educated workers were more concentrated in high-risk occupations in 2012 and have become even more concentrated in these occupations since then.
•The low growth in jobs in high risk occupations has not led to a drop in the employment rate of low-educated workers. This is largely because the number of workers with a low education has fallen in line with the demand for these workers.
•Going forward, however, the risk of automation is increasingly falling on low-educated workers and the COVID-19 crisis is likely to accelerate automation, as companies reduce reliance on human labour and contact between workers, or re-shore some production.
Prescription drug prices in U.S. more than 2.5 times higher than in other cou...Δρ. Γιώργος K. Κασάπης
Prescription drugs cost an average of 2.56 times more in the United States than they do in 32 other countries, according to a new report from RAND Corporation.
That disparity is even greater for brand name drugs, with U.S. prices averaging 3.44 times those in comparison nations. The study also found that prices for unbranded generic drugs — which account for 84% of drugs sold in the United States by volume but only 12% of U.S. spending — are slightly lower in the United States than in most other countries.
‘A circular nightmare’: Short-staffed nursing homes spark Covid-19 outbreaks,...Δρ. Γιώργος K. Κασάπης
Nursing homes have suffered grievously in the coronavirus pandemic. Chronically understaffed, that’s getting worse, a new US Pirg Education Fund analysis says. The shortage of direct-care workers rose from 20% of U.S. nursing homes in May to 23% in December. Too few workers raises stress among staff, the authors argue, making them and the residents they care for more vulnerable to Covid-19 infections, reducing staff further in “a circular nightmare.”
This document analyzes the impacts of utility disconnection and eviction moratoria policies on COVID-19 infections and deaths across US counties. It finds that policies limiting evictions reduced COVID-19 infections by 3.8% and deaths by 11%, while moratoria on utility disconnections reduced infections by 4.4% and deaths by 7.4%. Had these policies been adopted nationwide, infections could have been reduced up to 14.2% and deaths up to 40.7% with eviction moratoria, and infections reduced up to 8.7% and deaths up to 14.8% with utility disconnection moratoria. The document provides background on housing precarity and heterogeneity in government COVID-
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
The best massage spa Ajman is Chandrima Spa Ajman, which was founded in 2023 and is exclusively for men 24 hours a day. As of right now, our parent firm has been providing massage services to over 50,000+ clients in Ajman for the past 10 years. It has about 8+ branches. This demonstrates that Chandrima Spa Ajman is among the most reasonably priced spas in Ajman and the ideal place to unwind and rejuvenate. We provide a wide range of Spa massage treatments, including Indian, Pakistani, Kerala, Malayali, and body-to-body massages. Numerous massage techniques are available, including deep tissue, Swedish, Thai, Russian, and hot stone massages. Our massage therapists produce genuinely unique treatments that generate a revitalized sense of inner serenely by fusing modern techniques, the cleanest natural substances, and traditional holistic therapists.
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
English Drug and Alcohol Commissioners June 2024.pptxMatSouthwell1
Presentation made by Mat Southwell to the Harm Reduction Working Group of the English Drug and Alcohol Commissioners. Discuss stimulants, OAMT, NSP coverage and community-led approach to DCRs. Focussing on active drug user perspectives and interests
We are one of the top Massage Spa Ajman Our highly skilled, experienced, and certified massage therapists from different corners of the world are committed to serving you with a soothing and relaxing experience. Luxuriate yourself at our spas in Sharjah and Ajman, which are indeed enriched with an ambiance of relaxation and tranquility. We could confidently claim that we are one of the most affordable Spa Ajman and Sharjah as well, where you can book the massage session of your choice for just 99 AED at any time as we are open 24 hours a day, 7 days a week.
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As Mumbai's premier kidney transplant and donation center, L H Hiranandani Hospital Powai is not just a medical facility; it's a beacon of hope where cutting-edge science meets compassionate care, transforming lives and redefining the standards of kidney health in India.
CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdfSachin Sharma
Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
Exploring the Benefits of Binaural Hearing: Why Two Hearing Aids Are Better T...Ear Solutions (ESPL)
Binaural hearing using two hearing aids instead of one offers numerous advantages, including improved sound localization, enhanced sound quality, better speech understanding in noise, reduced listening effort, and greater overall satisfaction. By leveraging the brain’s natural ability to process sound from both ears, binaural hearing aids provide a more balanced, clear, and comfortable hearing experience. If you or a loved one is considering hearing aids, consult with a hearing care professional at Ear Solutions hearing aid clinic in Mumbai to explore the benefits of binaural hearing and determine the best solution for your hearing needs. Embracing binaural hearing can lead to a richer, more engaging auditory experience and significantly improve your quality of life.
At Apollo Hospital, Lucknow, U.P., we provide specialized care for children experiencing dehydration and other symptoms. We also offer NICU & PICU Ambulance Facility Services. Consult our expert today for the best pediatric emergency care.
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TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
At Malayali Kerala Spa Ajman, Full Service includes individualized care for every client. We specifically design each massage session for the individual needs of the client. Our therapists are always willing to adjust the treatments based on the client's instruction and feedback. This guarantees that every client receives the treatment they expect.
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VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVedanta A
Air Ambulance Services In Rewa works in close coordination with ground-based emergency services, including local Emergency Medical Services, fire departments, and law enforcement agencies.
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2. California’s health care paradox2
About the Lown Institute
Acknowledgements
The Lown Institute is a nonpartisan think tank dedicated to transforming
America’s high-cost, low-value health system. We conduct research,
generate bold ideas, and create a vision for a just and caring system of
health that works for all.
This report was co-authored by Shannon Brownlee, Senior Vice President
of the Lown Institute, Vikas Saini, President of the Lown Institute, and
Judith Garber, Health Policy and Communications Fellow at the Lown
Institute. This project was supported by funding from Well Being Trust,
a national foundation bringing together clinical, community, and
policy innovators to advance the mental, social, and spiritual health of
the nation. Ben Miller, Chief Strategy Officer at Well Being Trust, was
instrumental in helping conceive and design this project. Thanks also to
Janaya Nichols, project manager at Well Being Trust.
The Lown Institute relied on a research team at George Washington
University Milken Institute School of Public Health, including Jeffrey Levi,
Brian Bruen and Artisha Naidu, for performing the budget data analysis
and reviewing the manuscript. Leif Haase conducted multiple interviews
with policymakers and advocates to provide an on-the-ground perspective
on local attitudes about budget decisions. Thanks also to the rest of the
Lown Institute team: Aaron Toleos for design and communications work,
and Carissa Fu and Julia Healey for administrative help on this project.
3. California’s health care paradox3
Introduction
The rising cost of health care has become one of
the largest sources of stress on American household
budgets in the 21st
century. From premiums to
co-pays to prescription drug costs, families are
finding it increasingly difficult to pay for health care.
Since 2000, health care spending
has grown 3.4 times faster than
employee compensation, essentially
canceling out wage growth for most
low- to middle-income families.1
As health care costs have skyrocketed,
controlling them has become an
“extremely important” issue for
voters, second only to strengthening
the economy.2
Many families are
sacrificing spending on basic
necessities like food and clothing
to pay medical bills.3
Just as American household budgets are being squeezed by rising health
care costs, state budgets are also straining under the weight of health
care spending, leading to increasingly tight budgets for what should be
necessities—public education, public health, housing assistance, food
assistance, and income support.
This shift in resources away from “social spending” is having dire and
long-lasting consequences for the nation’s health and community
well-being. A large and growing body of evidence shows that there are
numerous factors besides medical treatment that affect our health.4,5
Some of these factors have been traditionally known as “socio-
economic determinants,” such as housing stability, financial security,
and educational opportunity. Other factors include environmental
quality, strong community ties, and adverse childhood experiences,
or ACEs, such as trauma or neglect.
4. California’s health care paradox4
FR
0%
10%
Health care
Social care
20%
30%
40%
12
21
SWE
12
21
SWIZ
11
20
GER
11
18
NETH
12
15
NOR
9
16
UK
8
15
NZ
9
11
CAN
10
10
AUS
9
11
US
16
9
Notes: GDP refers to gross domestic product.
Source: E. H. Bradley and L. A. Taylor, The American Health Care Paradox: Why Spending More Is Getting Us Less.
Public Affairs, 2013.
Together, these factors can be thought of as vital community conditions,
and they determine one’s health more than access to medical care.4
Yet the U.S. spends only 9 percent of its economy on improving community conditions,
through such programs as housing and income support—far less than most other
wealthy countries.6,7
This limited public financial investment in community conditions has led to worse
health outcomes in America compared to every other high-income country, despite
spending vastly more per capita on health care.8
The U.S. spends less on community conditions than other wealthy countries
PercentageofGDP
5. California’s health care paradox5
At the same time, high and rising health care costs are also putting pressure on state
budgets to reduce spending in other sectors.
The Government Accountability Office (GAO) identifies health care spending as
the major driver of state spending growth, warning of persistent fiscal instability.
The agency predicts that over the next several decades, state spending in all other
sectors will significantly decline to make up for increases in health spending.10
0
2
2008 2013 2018 2023 2028 2033 2038 2043 2048 2053 2058 2063
4
6
8
Simulation begins
PercentageofGDP
Health care expenditures
10
12
14
Source: GAO, see GAO-19-208SP.
Note: For more information about what’s included in the expenditures in this graphic, see the report.
Health and Nonhealth Expenditures of State and Local Governments as a Percentage of Gross Domestic Product (GDP): TXT I PDF
Nonhealth care, noninterest expenditures
State health expenditures on track to consume greater share of state GDP than all other
expenditures
MEDICAID SPENDING AS A PERCENTAGE OF STATE SPENDING IN THE US9
20.5%
in 2008
29%
in 2017
6. California’s health care paradox6
California is no exception to the state
budget squeeze from health care costs;
from 2007 to 2018, health care spending
rose by 146 percent, consuming 26
percent of the state budget in 2018.11
In 2007, California spent $1.22 on
public health, the environment,
and social services for every
$1.00 spent on health care—
but by 2018, for each dollar
spent on health care only $0.68
went towards public health, the
environment, and social services.
At the same time, California continues
to face the challenge of ensuring that
all people in the state have access to
necessary medical treatment.12
While
access to care is essential, the growing
imbalance between spending on health
care and spending on community conditions
means California is sacrificing potential
long-term health gains for short-term
health stopgaps.
This report examines the links between rising
health costs and spending on community
conditions, providing new evidence that
health care costs are putting pressure on
programs in California that are essential to
community well-being and the state’s health.
In addition, this report describes some of the
current barriers to action as well as potential
solutions. Key to improving health in the
state is to increase funding for community
conditions, a portion of which can be funded
by curbing the waste in health care and
redirecting those savings. California could
improve the health of its residents not only
by rebalancing investments in community
and health care spending within the state
budget, but also through the use of the state’s
convening power and regulation, without
sacrificing the recent gains made in much-
needed access to medical care.
Billions
0
FY 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
20
40
60
80
100
120
140
Social SpendingHealth Care
In California, health care spending has eclipsed spending on community conditions
7. California’s health care paradox7
Background
Increasing health care costs over the past few decades have
forced the state of California to sacrifice much-needed
investments in community conditions.
Previous research has shown that California, like other states, has been
responding to rising health care costs by constraining spending on
such community conditions as education, public health, environmental
protections, and social services. A 2017 study by Dr. Linda Tran and
colleagues from the UCLA Fielding School of Public Health found that
the fraction of California’s general fund expenditures spent on public
health and social programs fell from 34.8 percent in fiscal year 1990
to 21.4 percent in fiscal year 2014. At the same time, the proportion
spent on health care increased from 14.1 percent to 21.3 percent.11
Over 25 years, California’s ratio of spending on social services compared
to medical care decreased from 2.5 to a ratio of one-to-one.
How is California allocating its
resources for health?
STATE SPENDING PER CALIFORNIA RESIDENT
$814
$330
$613 $613
1990 19902014 2014
Health care spendingSpending on community
conditions
8. California’s health care paradox8
Even spending on education has been
squeezed in California, where about 40
percent of the state budget is allocated to
K-12 and community college (depending
on changes in student attendance and state
revenues).13
Propositions 98 and 111, passed
in 1988 and 1990, respectively, mandate this
spending. Nevertheless, per capita K-12
spending in California still lags behind the
national average when adjusted for cost of
living, and the state has the highest K-12
student-to-teacher ratio in the nation.14
Higher education spending as a share of
the state budget has fallen over the past
forty years, from 18 percent of the budget in
1976-77 to 12 percent in 2016-2017. This has
resulted in significant decreases in funding
per student at California’s largest public
universities, despite Proposition 30 in 2013,
which raised taxes for state schools.15,16
At the
University of California, for example, funding
per student fell from $23,000 in 1976 to about
$8,000 in 2016.16
Methods
The analysis included in this paper looks at
the distribution of California State Budget
expenditures between state fiscal years
2007-08 and 2018-19. For 2007-08 through
2016-17, we used actual total expenditure
amounts reported in enacted State Budgets
from all funds, which include state, federal,
and other sources. For 2017-18 we used
estimated expenditures and for 2018-19 we
used projected expenditures. We obtained
State Budget documents from the California
Department of Finance at ebudget.ca.gov,
between November 2018 and January 2019.
We classified expenditures into the
following categories: corrections, education,
environmental protection, health care,
public health, social services, and other
services and operations. Education
includes both K-12 education and higher
education. Health care includes Medi-Cal
(California’s Medicaid program), health
care for the incarcerated, state employees’
and retirees’ health benefits, and other
health care services such as state hospitals.
Public health includes the Department of
Public Health as well as services such as
primary, rural, and Indian health clinics and
statewide health planning. Social services
include expenditures for income and job
support programs, housing, food and
nutrition services.
We classified expenditures at either the
State Agency, Department, or Program level.
Program-level assignment was used when
we could clearly separate expenditures within
a department. For example, we separated
expenditures for health care services for the
incarcerated from other corrections-related
expenditures. We based our classifications on
the dominant type of service provided within
the State Agency, Department, or Program.
We determined state contributions to
health care benefits for public employees
and retirees through the California
Public Employees’ Retirement System
(CalPERS) from tables included in the
“Statewide Issues” sections of the 2018-
2019 Governor’s Budget Summary, 2016-17
Governor’s Budget Summary, and 2014-15
Governor’s Budget Summary documents
at ebudget.ca.gov. We classified these
expenditures as spending for “Health Care,”
and removed them from other staff and
program administration expenditures under
“Other Services and Operations.”
We chose to use total expenditures from
All Funds, which includes federal dollars,
rather than total State Funds because the
State Budget documents do not provide State
Fund-level detail below the Department
level. Other recent analyses have examined
state-only expenditures in California.11
9. California’s health care paradox9
Results
Between 2007 and 2018, spending on health care rose 146 percent, from
$48 billion to $119 billion, while spending on social services, public health,
and the environment grew by just 36 percent.
In 2007, California spent $1.22 on public health, environment, and social services for
every $1.00 spent on health care. By 2018, however, the state spent much less on these
community conditions relative to health care: for each dollar spent on health care, only
$0.68 went towards public health, environment, and social services.
California’s spending on social services, including direct income support, housing support,
and nutrition services, has increased moderately over the past decade, rising by 36 percent
from 2007-2018. Spending on environmental protections, such as parks and recreation,
water resources, and wildlife conservation services, increased by 34 percent, and public
health spending increased by 46 percent.
As noted earlier, education spending represents a special case in California because the
state mandates that K-12 education and community college receive about 40 percent of
general fund expenditures. From 2007 to 2018, spending on K-12 education increased
by 32 percent, from $66.8 billion to $87.8 billion. Per capita K-12 education spending
increased by 33 percent, from $10,644 to $14,246 per student, as K-12 enrollment
declined slightly from 2007 to 2018.17,18
Billions
0
FY 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
20
40
60
80
100
120
140
Public Health
Environment
Social Services
Health CareK-12 Education
Higher Education
California Budget Spending Over Time
10. California’s health care paradox10
Higher education spending rose by a
larger 56 percent, from $38.4 billion
to $59.8 billion, likely due to increased
funding from Proposition 30 passed in
2012. Including spending on education,
California’s spending on community
conditions increased by 39 percent
from 2007 to 2018.
However, the increase in spending
on community conditions is small
compared to the rapid rise of health
care spending over the past decade.
Health care spending skyrocketed from
$48.3 billion in 2007 to $118.9 billion in
2018, a relative increase of 146 percent.
Total health spending increased from
16 percent of general fund expenditures
in 2007 to 26 percent by 2018.
-50%
FY 2007 to FY 2018
0%
50%
100%
150%
200%
Public Health
Environment
Social Services
Health CareK-12 Education
Higher Education
Relative Percent Change in California Budget Spending, 2007-2018
HEALTH CARE SPENDING INCREASED
BY $70 BILLION
$118.9
BILLION
$48.3
BILLION
2007 2018
146%
increase
11. California’s health care paradox11
Medi-Cal, California’s Medicaid program, saw
the greatest increase, due to higher enrollment
and rising spending per enrollee. From 2007
to 2018, Medi-Cal enrollment increased by 106
percent.19-21
Although federal support covered
most of the cost of the new enrollees under the
Medicaid expansion, it should be noted that
total state spending on Medi-Cal also increased
by 95 percent from 2007 to 2018.22
While Medi-Cal accounted for the lion’s share
of increased spending on health care, spending
also increased for other health care categories,
including state employees and retirees, and
prisoners. Total spending on health care for the
incarcerated increased by 44 percent, and per
capita spending also rose 93 percent, from about $13,000 in 2007 to $25,400 in 2018.23,24
Total spending on health care for state employees and retirees increased by 83 percent,
from $4.3 billion in 2007 to $7.8 billion in 2018. CalPERS accounted for 7 percent of the
total health care spend by the state in 2018. This increase in spending was largely due
to rising spending per beneficiary. The number of CalPERS beneficiaries increased by
12 percent between 2008 and 2017, while per capita spending increased by 43 percent.25
12. California’s health care paradox12
While California should be lauded for expanding Medi-Cal,
which provides access to needed treatment and care for
millions, and protects enrollees from the financial toxicity
of health care bills, the expanding costs of health care and
relatively meager increase in spending on community
conditions have important consequences.
In many zip codes in the San Joaquin Valley, for example, environmental
factors such as toxic air and water pollutants, and social factors such as
high rates of poverty, food deserts, and low levels of formal education,
lead to disproportionately high rates of chronic health issues and lower
life expectancy.26,27
In Madero, Kings, and Fresno counties, for example,
the rates of asthma-related emergency room visits by young children is
twice that of the state overall.
Health disparities are stark even within counties. In the poorer Edison
neighborhood of Fresno, the rate of hospitalization for diabetes is
39/10,000 people; in the affluent Woodward park neighborhood, the
rate is 1/10,000.28
Health and Health Care:
Why Community Conditions Matter
RATE OF HOSPITALIZATION FOR DIABETES
39 / 10,000
people
1 / 10,000
people
Poorer Edison
neighborhood
Affluent Woodward park
neighborhood
vs.
13. California’s health care paradox13
These and many other health disparities can be laid at the feet of poor community
conditions. Lack of access to a steady income, education, good food and clean water,
stable housing, a safe family environment, and community ties have a significant impact
on community health. For example, studies find that lower educational attainment is
associated with lower life expectancy, worse reported health, and higher rates of infant
mortality. Conversely, higher income levels are linked to better reported health status
and lower incidence of chronic disease.5,29,30
The impact of community conditions on population health is substantial. In the year
2000, deaths attributable to low education, racial segregation, and poor social supports
were comparable to deaths from heart attack, stroke, and lung cancer.31
A 2019 review of
determinants of health found that the majority of premature mortality can be attributed
to behavioral and social factors; lack of access to health care and poor quality care
contribute less than 17 percent to premature mortality.30
Life Expectancy by Zip Code, San Joaquin Valley, California
15. California’s health care paradox15
Health and Financial Benefits of Social Spending
Social Program Health Effects Return on Investment
Earned Income
Tax Credit
Having a state EITC is associated
with a reduced low birthweight
rate by 4-11%.37
A 10% increase
in the EITC reduced infant
mortality by 0.23%.38
In California, EITC payments
in 2007 contributed $5 billion in
output and added 30,000 jobs to
the state economy, for $4.5 billion
in EITC claims.39
Housing support Access to affordable housing
reduces psychological distress,
ED visits, and improves
reported health of children.
Programs to improve housing
quality reduce asthma ED
visits in children and increase
opportunities for physical
activity.33
Provision of affordable housing
in Oregon decreased Medicaid
expenditures by 12 percent, an average
of about $50 per member per month.36
Another housing program that gives
supportive housing to chronically
homeless saved an estimated $29,000
per person per year.40
SNAP (Supplemental
Nutrition Assistance
Program)
Access to SNAP in childhood
reduces rate of stunted growth
by 6%, reduces heart disease in
adulthood by 5%, reduces rate
of obesity by 16%.41
Every $1 increase in SNAP benefits
during 2009, when the economy was
in a recession, generated about $1.70
in economic activity.42
Early childhood
education
Early childhood education
programs lead to reduced
hypertension, obesity, illegal
drug use, and high cholesterol
in adulthood.43,44
High-quality early childhood programs
yield an estimated $4 – $9 dollar
return per $1 invested.45
One early
childhood program for disadvantaged
children ages 0-5 produced a $13 dollar
return per $1 invested.44
Implications
Given the influence that community conditions have on health, why has California, and
indeed every other state in the U.S., made the choice to prioritize health care over social
programs, public health, the environment, and even education? These decisions should
not be surprising, given that political discourse on health at the local, state and national
level is rarely framed in terms of community conditions, but rather in terms of access to
health care and affordability. According to a survey from the Harvard T.H. Chan School
of Public Health, more Americans attribute ill health to lack of access to medical care
compared to environmental factors, stress, or personal behavior.46
16. California’s health care paradox16
For taxpayers and legislators, however, increasing coverage has an additional meaning
—more spending on health care. As health care becomes more expensive, coverage
becomes more difficult to achieve within a limited state budget. In discussions about
coverage, the tension between the need for coverage and the need to control spending
may acknowledge the high cost of health care, but it is usually treated as a given. Rarely
is the topic of rising health care spending by the state framed as potentially limiting the
opportunity to improve health through other forms of public spending (See Stakeholder
Perceptions of Budget Tradeoffs).
This leaves lawmakers and public officials with a dilemma. To the extent that they
recognize the profound importance of community conditions to health, they have
a limited number of options. They can raise taxes in order to broaden coverage and
simultaneously boost spending on community conditions; or they can cut other
programs, such as transportation and law enforcement. Neither of these approaches
holds much appeal for either side of the aisle.
There is a third option: cutting health care costs. There are two paths to lower
health care costs, one of which is reducing Medi-Cal rolls, restricting benefits to
beneficiaries, and/or forcing current and retired state employees to shoulder more
of the burden of their own coverage. These actions would impose a harsh burden on
millions of Californians, increasing medical debt along with rates of unmet medical
needs and ill health, which would worsen health outcomes and could increase health
care spending in the long run.47
The other path to cutting health care costs lies in addressing the waste in
the system, by reducing overpriced or unnecessary health care services.
There is ample evidence for the opportunity to cut waste in health care nationally,
and some evidence that health care costs can be reduced even in California, where
payment rates to many health care providers are low relative to much of the rest of the
country. Cutting waste in the delivery of health care would allow the state to rebalance
its investments in community conditions and health care spending without cutting
enrollment or benefits.
The remainder of this report examines a variety of approaches to curbing health care
costs, some of which also offer the possibility of simultaneously improving the quality
of care and making care safer. These solutions include regulatory actions the state can
take to rein in health care costs, and ways in which the state can partner with and support
organizations that are currently working to improve community conditions and health.
17. California’s health care paradox17
Stakeholder perceptions of
budget tradeoffs
In a series of interviews with fifteen local
policymakers and state health advocates, we
found that, overall, policymakers and advocates
saw health care access and funding as the biggest
health issues in California.
While the officials and advocates we spoke with had a wide
range of understanding of, and interest in, community
conditions, most felt that they could not or should not be the
focal point of their health reform strategies. The absence of
community conditions in public narratives about health and health care is reinforced
by two key factors: siloed agencies in charge of funding for various aspects of both
health care and health-promoting social, environmental and public health programs;
and health care funding structures and incentives that push toward more health care
spending, not less.
For example, although Medi-Cal spending as a share of California’s budget has grown
significantly, many advocates and policy makers expressed concern that California
trails behind most states in how much it spends per enrollee. Advocates and policy
makers also remain concerned about the more than three million California residents
who still lack coverage. They believe that Medi-Cal must raise payment rates to health
care providers to address the physician shortage in underserved areas.
State and local officials also have several economic incentives to spend more on
health care. For one, the federal government provides matching funds for Medi-Cal,
paying for 50% of the cost for those enrolled before the ACA expansion, and 100% of
the cost to cover new enrollees after 2014 (dropping to 90% after 2016). There are no
obvious economic advantages for state policymakers to reduce health care spending,
because saving money in health care only loses them matching federal funds.
On a local level, policy makers are more interested in capturing state health care
funding than considering tradeoffs with spending on community conditions.
Because most of California’s revenue is raised at the state level, not the local level
(due to limited property tax revenues and the progressive state income tax), local
policymakers have to compete for health care funding from the state. From the
perspective of most local officials and advocacy organizations, it is invariably a
matter of garnering the most dollars from Sacramento, not worrying about the
cost of the care delivered in their locality.
18. California’s health care paradox18
Local policymakers also do not perceive a tradeoff between health care spending and
spending on community conditions because, most of the time, they must rely on
siphoning off health care dollars to use as seed money for projects that have an impact
on those community conditions. Without using health care funding, there is no other
way to get these projects off the ground, except for grants from foundations or local
business groups, sources that are unstable and often time-limited.
“Getting the ambulance there on time, or the wheelchair for
the kid, or the trauma victim to the right specialist dominates
the experience of any local administrator who must engineer
solutions in perpetual scarcity and the reality of pervasive and
preventable human suffering.”
– Alex Briscoe, former public health director, Alameda County
The one area where local and state policy makers are being forced to acknowledge
and confront directly the high cost of health care is through the lens of retiree health
care obligations to state employees, teachers, firefighters, and other workers. At the
state level, CalPERS’ health care obligations to current employees and retirees are
dwarfed by monies devoted to Medi-Cal, but even so, there has been an intense
debate over the scope, generosity, and eligibility standards for public sector pensions.
The argument that pension costs are too high, the reserves for meeting them too low,
and the terms for vesting in pensions too permissive, has been made by Republicans
and also by some Democrats, and in particular by several mayors. Like the general
debate about coverage, the high cost of health care is acknowledged but treated as a
given. The argument invariably focuses on whether or not other post-employment
benefit obligations can be paid for, rather than on considering ways in which the
underlying costs of providing health care can be reduced.
19. California’s health care paradox19
Tackling health care waste and price inflation
Nationally, a significant proportion of health care spending
in the U.S. is wasted on a variety of factors and processes
that do nothing to improve the health of patients but
merely drive up costs.
At least 18 percent of health care spending, and perhaps as much as
37 percent, is lost due to a combination of inefficient processes,
excessive administrative overhead, unnecessary care (also called
overuse), and excessive prices.48
Assuming the minimum level of waste
at the national level applies to California’s health care system, that’s
$20 billion of health care spending in the state’s budget that is wasted
each year. These wasteful practices also affect costs for employers,
private insurers, and Medicare.
Prices
An essential part of reducing health care waste will be tackling
overpriced services and products. Drug prices are a well-known source
of unnecessary expense, and market pressures are insufficient to keep
medications affordable. The state currently spends about $38 billion on
prescription drugs and other non-durable medical products.49
Allowing
the state to negotiate drug prices with manufacturers, as Governor
Gavin Newsom has proposed, would be a good first step toward reducing
costs. California could also go a step further and create a state-run
pharmacy benefit manager (PBM) to offer negotiated prices to all
Californians, not just state beneficiaries.50
Prescription medications are not the only source of inflated prices
in health care. Hospital charges and physician fees are often highly
inflated, especially when large hospital systems control market share
and can dictate prices. These prices affect how much CalPERS must
pay for insurance for employees and retirees. A report from the Health
California’s options for action
to improve health
20. California’s health care paradox20
Care Pricing Project found that monopoly hospitals charge 12 percent more for their
services than hospitals with four or more local rivals.51
Price transparency is often
raised as a means of controlling prices of health care services, and grassroots efforts
like Clear Health Costs, which provide a database of prices patients have paid, can save
individuals money in the short run.52
However, efforts to make hospital and physician
prices transparent have had minimal effect on prices paid by insurers.53
One stronger measure for controlling prices would be enforcing anti-trust laws for
monopoly hospital systems like Sutter Health, which has been accused of overcharging
patients for health care services and failing to meet community benefit obligations.54,55
California policymakers should also consider converting hospital payments to a fixed
total revenue system, often called “global budgeting.” In Maryland, the switch to
global budgeting for all hospitals has saved Medicare over $400 million in five years,
by reducing growth in hospital spending to an average of 1.38 percent, which is
2.2 percent less than the state’s long-term economic growth rate. Bringing California
hospital spending growth down from its current 3.1 percent to 1.38 percent per year
would save about $2.7 billion over five years.56
Excess volume of services
When global budgeting is not in place, spending in health care is the result of price
multiplied by the volume of services. There is increasing evidence that a significant
portion of what is delivered to patients does nothing to improve their health and
often needlessly puts them at risk of serious harm.57
Regardless of how high or low
the price per unit of health care services may be, payers are spending money on care
that is unnecessary and may harm patients unnecessarily. Reducing the volume of
such “low-value care” (health care services that provide minimal or no health benefit
to the patient) is another potential source of significant health care savings. A study
in Washington state examined 48 commonly used health care services, and found
that 47 percent of spending on these treatments were of low value.58
Examples of
these services include MRI for low back pain, routine cardiac stress testing, and PSA
(prostate cancer) screenings. In a year, the state spent $341 million on these low-
value services.58
As a state with more than five times the population of Washington,
California likely spends more than $1.5 billion on these 48 low-value services alone.
Examples of initiatives to reduce low-value services include case conferences,
electronic medical record prompts, letters to clinicians showing how their delivery of
low value services compares to that of peers, and clinician awareness and education
initiatives.59-61
One such initiative is SmartCare California (SCC), a public-private
partnership led by the Integrated Health Association (IHA) that brings together the
state’s leading health care purchasers, who are working together to get providers to
avoid unnecessary services. (The targeted services are based on recommendations
created by the Choosing Wisely initiative.) Currently, SCC is targeting opioid overuse,
21. California’s health care paradox21
unnecessary c-sections, and surgical procedures for low-back pain.62
Additionally,
IHA partners with physician specialty groups and large hospital systems on other
commonly overused services, such as reducing preoperative stress testing and
repetitive lab testing.63
These programs are promising steps toward reducing low-
value care. Future initiatives could focus on reducing unnecessary cardiovascular tests
and procedures (a highly costly category of overuse), unnecessary hospitalizations,
and overscreening for cancer in low-risk populations.64
Improving care delivery processes
California has already embarked on initiatives intended to improve health care
delivery, such as the Medicaid Delivery System Reform and Incentive Program (DSRIP).
The DSRIP pilot in California ran from 2010 to 2015, and was renewed again for
2015-2020. The program gives funding to public hospitals in exchange for achieving
certain metrics, including building health technology infrastructure and primary care
capacity, improving chronic disease management, reducing in-hospital infections, and
integrating health care with human services.65,66
The final evaluation of the 2010-2015 pilot was encouraging. Overall, 97% of the
3,764 milestones set for DSRIP projects were achieved. Participating hospitals
reported that DSRIP had a high or very high impact on improving patient outcomes
and quality of care, and a medium-to-high impact on containing costs.66
Examples
of cost-saving outcomes from the demonstration include an overall 20 percent
reduction in hospitalizations of diabetes patients for short-term complications and a
22 percent decline in rates of central line infections in the ICU.65
The 2015-2020 DSRIP
demonstration, “Medi-Cal 2020” builds on the previous pilot, including alternative
hospital payment programs,such as global budgeting for uninsured patients.67
Maryland hospitals have demonstrated that the shift to global budgets can be made
by a large number of hospitals within a few years, and California should consider
following in their path, using global budgeting for all patients covered by the state.
Supporting investments in community conditions
The point of reining in health care spending is to provide more resources for
community conditions for health. A crucial path to improving health is to increase
state spending on social programs, public health, education, and the environment.
This could include increasing the minimum wage, increasing the state Earned Income
Tax Credit, implementing universal child care, allocating more funding to higher
education, anti-homelessness initiatives, rent support and development of more
affordable housing, and many more.
22. California’s health care paradox22
Ongoing efforts to improve community conditions
There are multiple ongoing efforts to address the need for greater investment in
community conditions in the state. One initiative, called the California Accountable
Communities for Health Initiative (CACHI), brings together health care providers with
public institutions and community groups, to improve community health through
coordination of health care and social services, with a focus on community conditions.
CACHI provides formal infrastructure for partnerships, sustainable funding, community
engagement, and data collection, to maximize limited resources for the largest impact.68
Another current project to unite health and social programs is the Whole Person Care
(WPC) pilot program, part of the “Medi-Cal 2020” demonstration. WPC Pilots provide
local governments and health care institutions with support to integrate health care,
behavioral health, and social services for Medi-Cal patients with poor health outcomes
and complex needs. Eighteen WPC pilots were approved in the first round of applications,
to provide services including include care management, wellness education, addiction
treatment, housing services, and more.69
Aligning incentives for community health
While current efforts to improve community
conditions are promising, these programs exist only
in a handful of California communities and have
limited support from the state. Too many people
are being left behind because government and
health care institutions have little incentive to work
together with community organizations to fully
invest in community conditions.
One of the greatest barriers to states making major
investments in community conditions is that the
government body making the upfront investment
may not receive all of the financial benefit that accrues from improving health.70
For example, agencies making investments in education do not see the full return on
investment, because the benefits are dispersed throughout society, through lower rates
of incarceration, reduced health care utilization, and economic growth. Moreover, large-
scale investments in community conditions are often seen as too costly or risky for a
single governmental agency to undertake on its own, especially if the benefits will only
be seen far in the future.
23. California’s health care paradox23
There are several steps California could take to solve this problem. One is aligning
financial incentives of health systems with improving community health through
alternative payment models (as do Maryland’s Global Budgeting system and Medicaid
Managed Care). Health care institutions that are paid fee-for-service have little incentive
to contribute to government investments in community conditions, because they lose
money when people are healthier. Rewarding health systems for patient outcomes rather
than the volume of services they provide can catalyze more partnerships between health
systems and community-based social programs.71
However, California could go a step further, by uniting all stakeholders
that benefit from investments in community conditions to invest together
in larger-scale projects to improve health. California should build on the
positive experience of CACHI and turn it into a statewide initiative, so
that state programs are fully leveraged into these efforts.
By pooling their resources into “Wellness Funds,” as many other cities and communities
have begun to do, California government agencies, employers, and hospitals can better
improve the health of the state’s residents, and provide a larger health return on
investment for all.72
The state should be a catalyst for these “co-venture” projects by providing the
seed capital; bringing stakeholders to the table (including health care institutions,
community social service providers, and Community Development Financial
Institutions); incentivizing non-profit health systems to participate through new
community benefit requirements; creating the infrastructure for sustainable pooled
funds; providing incentives within Medi-Cal to invest in community conditions; and
commissioning research to calculate the downstream savings of upfront investments
in community conditions.73
24. California’s health care paradox24
Conclusion
Like many states and the families that live in them,
California is feeling the pressure of rising health care
costs on its budget, forcing tradeoffs in spending on
programs that matter equally as much as health care in
terms of their impact on community well-being and
the population’s health.
This pattern is perhaps less discernable in the state’s budget than in
family budgets, but it is just as difficult to fix. Moreover, the structure
of health care funding in California makes it beneficial for policymakers
not to acknowledge the tradeoffs that are occurring between health care
spending and investing in the community conditions that have such a
profound impact on health.
However, if the current trends in state spending continue and tax
revenues do not rise, the cost of health care in California will absorb
more and more of the budget, further crowding out spending on
community conditions. Though some of this health care spending will
be put to good use expanding coverage, hundreds of millions—if not
billions—more will be wasted on overpriced services, low-value care,
and administrative inefficiencies.
The state has three ways it can respond: raise taxes, constrain health
care spending, or both. None of these choices will be easy, and they will
not be made until state officials, community activists, and the public
recognize the importance of community conditions to health—and
commit to addressing the waste in health care. Most of the savings from
reducing that waste must be redirected toward increasing funding for
social, environmental, and community programs. The long-term health
of the state depends on it.
25. California’s health care paradox25
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