The document discusses the issue of inadequate and unaffordable healthcare in the US, highlighting that 49.9 million Americans lack health insurance. It identifies groups most affected like minorities and those with lower incomes. A lack of preventative care leads to increased costs. Potential solutions discussed include expanding Medicaid eligibility and the models of the Veterans Health Administration and systems in France and Italy. New approaches like eReferral aim to improve access to specialty care.

1. Deirdre Farrell, Zohal Ghiaszada, Erin Greco, Shevaun Harris, and Nina Hicks Quinnipiac University HM 600

2. Illustrates the growing issue facing the U.S. in terms of inadequate access to quality affordable health care for the uninsured and underinsured Highlights the impact on the overall health care delivery system Identifies potential health care models of success Reviews solutions offered through the Patient Protection and Affordable Care Act

3. 49.9 million Americans lacked health insurance Approximately 25 million individuals between the ages of 19 – 64 are underinsured There is a strong correlation between access to health insurance coverage and better health outcomes

4. Inadequate health care coverage disproportionately affects minorities: 20.8% of Among African Americans 30.7% of Hispanics 11.7% of Caucasians 9.8% of children Individuals with lower incomes are at a higher risk

5. Erosion of Private Health Coverage Intermittent Gaps in Coverage Lack of Affordability of Health Insurance Other Barriers Lack of knowledge about other available resources Inability to pay out of-pocket expenses Childcare Difficulty taking time off from work Transportation Past Experiences

6. Lack of preventative health care Delayed follow-up treatment Increased risk for hospitalization Higher levels of ER usage Higher rates of medical morbidity

7. Medicaid is an entitlement program for the poor and disabled Categorical eligibility requirements Income eligibility requirements Residency requirements Citizenship status requirements State Children’s Health Insurance Program (SCHIP) Covers children who are ineligible for Medicaid

8. 48.6 million individuals are covered by Medicaid Over $300 billion spent on the Medicaid program Limited coverage for non-disabled adults under the age of 65 without dependent children States can impose more restrictive eligibility requirements and benefit coverage

9. Increase in national health expenditures $2.5 trillion spent in 2009 (4% increase) The uninsured pay $30 billion in out of pocket expenses $56 billion in uncompensated care $122 billion more needed to cover uninsured

10. Solutions and Challenges

11. “ It is vital that health reform reduces costs to make health care affordable; protects a patient's choice of doctors, hospitals, and insurance plans; invests in prevention and wellness; and assures quality, affordable health care for all Americans.” (Halle, Lewis, & Seshamani, 2009)

12. Managing the high prevalence of chronic diseases Improving access to care Preventing the lack of routine care

13. STRENGTHS CHALLENGES Decrease health care costs Develop an advisory group Funding for chronic disease prevention and management Incentives for Medicaid enrollees Prevent denial because of pre-existing conditions Need individual incentives for people to lose weight Need to pay doctors and hospitals differently to compensate for time and effort on prevention

14. STRENGTHS CHALLENGES Provides affordable options for purchasing health coverage Extends dependent health insurance coverage until the age of 26 Expands Medicaid eligibility requirements Increase funding to train more doctors Increase access to quality care Shortage of primary care physicians Project shortage of 63,000 doctors in 2015 Need at least 15% more medical students than projected 7,000 from the increased funding Longer wait times to see doctor

15. STRENGTHS CHALLENGES Creation of the Prevention and Public Health Fund Investment in tobacco cessation programs Increase funding for prevention and screening programs Eliminates co-payments, co-insurance, or deductibles for preventative services Longer wait times to get an appointment Physician shortages Increase usage of the emergency room Increase in preventable deaths as a result of reduced physician access

16. Veterans Health Administration

17. Model for low-cost and high-quality healthcare since the mid-1990s Nation’s largest integrated health care system 1,400 sites 152 medical centers

18. Provides a full array of preventative services 53,000 independent licensed health care practitioners 83 million veterans served each year Priority group enrollment Co-payment exemptions Purple Heart Recipient Prisoner of War Service-Connect Injury

19. Dr. Kenneth Kizer, former undersecretary of the Veterans Administration (VA) Transformed the VA health system under his leadership in the mid-1990s Outpatient focused care Decentralization System-wide computer network Patient centered approach

20. As a government entity, the VHA cannot be sued for malpractice Focus on preventative medicine Electronic records system Lower overhead and administrative costs Higher customer satisfaction index than private institutions

21. France and Italy

22. First major study of the world’s healthcare systems in 2000 Evaluated on 5 criteria: Overall level of the population’s health Health inequalities within the population Overall level of the health system’s responsiveness Distribution of responsiveness within the population Distribution of financing the systems between economic classes in each population

23. 1 st Place – France 2 nd Place – Italy 37 th Place – United States

24. Hybrid of socialized and competitive systems Universal coverage– no uninsured The sicker you are, the less you pay Full reimbursement for treatment, drugs, surgeries, and procedures for chronic illnesses. 10-11% of Gross Domestic Product 21% of income is paid to the national healthcare system Employers pay between 11-13% Supplemental coverage

25. Highest satisfaction levels in Europe Average Life expectancy – 80.5 years

26. “ There are no uninsured in France. That's completely unheard of. There is no case of anybody going broke over their health costs. In fact, the system is so designed that for the 3 or 4 or 5 percent of the patients who are the very sickest, those patients are exempt from their co-payments to begin with. There are no deductibles.” -- Victor Rodwin

27. Servizio Sanitario Nazionale (SSN) Mandatory universal healthcare coverage No uninsured All essential healthcare services Autonomous regions Low satisfaction rate Quality issues Waiting lists

28. Can potentially decrease quality Competition between public and private

29. eReferral and eConsult

30. Demand >> Supply Onerous and unreliable referral system Lack of equitable triage Poor communication between specialists and primary care providers (PCP)

31. Patients Experiencing Problems Obtaining Specialty Care: Uninsured – 80% - 90% Medicaid and Medicare- 40% - 50% Private Insurances – 5 – 10%

32. Handwrite/fax the referral form Loss of referral documentations No centralized method to track the referrals Reason for consultation (include pertinent history, physical laboratory findings, medications)

33. Proven model in safety-net facilities serving the uninsured Enhance efficiency and improve communication between specialists and PCPs Improve triage of referrals Goals Reduce demand Increase efficiency Improve quality Enhance timely access

34. BENEFITS NEXT STEPS Health Reduces mortality and morbidity Economical Cuts down healthcare expenses Social Reduced inequities and disparities Spread to other departments Radiology (MRI, CT, U/S) Build relationship and trust Other specialists

35. National healthcare reform is already showing some success with the uninsured and underinsured Successful Models for Addressing the Issue: Veterans Healthcare Administration Key Elements in Any Approach Must focus on quality Patient centered Builds upon partnerships