HIV in USA Outline: The universal health coverage in US Health policy in USA. Comment about the individualism Vs collectivism in US. Discuss main risk factors for CVD and the strategy to counter these risks. Absolute contra-indications for liver transplantation. Incidence, prevalence, & mortality of HIV/AIDS.

1. HIV in
USA
Kholoud Al-Harbi
Group 3
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2. Outline

 The universal health coverage in US:
 Health policy in USA.
 Comment about the individualism Vs collectivism in
US.
 Discuss main risk factors for CVD and the strategy to
counter these risks.
 Absolute contra-indications for liver transplantation.
 Incidence, prevalence, & mortality of HIV/AIDS.
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3. Statistics

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4. OECD = Organisation for Economic Co-operation and Development.
USA health expenditure

 Health spending in the USA is much higher than in other OECD countries.
 US spends two-and-a-half times more than the OECD average health
expenditure per person.
 A 2010 OECD study (Koechlin et al., 2010) found the US price level of hospital
services to be over 60% higher than the average of OECD countries.
 America is more effective at delivering high costs in health care than quality
care.
 It is also amongst the industrialized countries with the highest number of
people with no healthcare cover or inadequate healthcare cover.
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5. USA health expenditure

U
S
A
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6. USA health expenditure

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7. Why is US healthcare spending
so high?

According to the OECD report, there are several reasons
including:
 Ambulatory care provider spending
Spending on doctors, specialists and dentists is two-and-a-half
times higher than the OECD average.
 Medications and medical goods expenditure
the price of medications in USA is 60% higher than the other
five largest economies in the OECD.
 Public health and administration spending
is 150% higher than the OECD average.
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8. Universal Health Coverage
in USA

 The absence of universal health insurance coverage is one of the
great, unsolved problems facing the United States at the onset of the
21st century.
 The American health care system relies on a patchwork of insurance
coverage.
 This system has serious consequences for the approximately 39 million
Americans who are left without insurance as well as for those with
inadequate health insurance.
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9. Health policy

Health care in US is provided by many distinct organizations.
 Largely owned and operated by private sector businesses.
 62% of the hospitals are non-profit, 20% are government
owned, 18% are for-profit
 60–65% of healthcare provision and spending comes from
programs such as:
 Medicare; for elderly and disabled.
 Medicaid; for low-income adults.
 TRICARE.
 Children's Health Insurance Program; for children.
 Veterans Health Administration.
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10. Health policy

 Most of the population under 67 is insured by their or a family
member's employer, some buy health insurance on their own, and
the remainder are uninsured.
 Health insurance for public sector employees is primarily
provided by the government.
 Health insurance also covers insurance for disability or long-term
nursing care.
 Different health insurance provides different levels of financial
protection and the scope of coverage can vary widely.
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11. Health policy

 The share of Americans with health insurance has been
steadily declining since at least 2000.
 Declining rates of coverage and underinsurance are
largely attributable to rising insurance costs and high
unemployment.
 As the pool of people with private health insurance has
shrunk, Americans are increasingly reliant on public
insurance.
 Public programs now cover 31% of the population and
are responsible for 44% of health care spending.
 Public insurance programs tend to cover more vulnerable
people with greater health care needs.
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12. Individualism Vs
Collectivism in USA

 The United States can clearly been seen
as individualistic (scoring a 91).
 The “American dream” is clearly a
representation of this.
 This is the Americans’ hope for a better
quality of life and a higher standard of
living than their parents’.
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13. Risk factors for CVDs

High blood
pressure
High LDL
cholesterol
Smoking
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14. Risk factors for CVDs

 Other medical conditions and lifestyle including:
 Diabetes
 Overweight and obesity
 Poor diet
 Physical inactivity
 Excessive alcohol use
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15. Strategies for CVD Risks
Reduction

Reducing Out-of-Pocket Costs for
Cardiovascular Disease Preventive Services for
Patients with High Blood Pressure and High
Cholesterol (ROPC)
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16. The intervention

 Patients' out-of-pocket costs are reduced by
establishing programs and policies to provide blood
pressure and cholesterol lowering medications at no
cost or reduced cost.
 Several studies evaluated the effect of reducing out-of-
pocket cost within the context of an insurance
design. This insurance design reduces patients' out-of-
pocket costs for medical services.
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17. Results from the Systematic

 Fourteen studies were included in the review.
 ROPC was associated with improvements in
medication adherence, and blood pressure and
cholesterol outcomes.
 Blood Pressure
 Patients' systolic & diastolic blood pressure decreased
 Cholesterol
 Patients' total cholesterol, LDL, & triglycerides
decreased.
Review
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18. Strategies for CVD Risk
Reduction

Team-Based Care to Improve Blood
Pressure Control
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19. Team-Based Care to Improve
Blood Pressure Control

 A health system-level, organizational intervention
that incorporates a multidisciplinary team to
improve the quality of hypertension care for
patients.
 Established by adding new staff or changing the
roles of existing staff to work with a primary care
provider.
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20. Activities

Facilitate communication and coordination of care support
among various team members
Enhance use of evidence-based guidelines by team
members
Establish regular, structured follow-up mechanisms to
monitor patients' progress and schedule visits.
Actively engage patients in their own care by providing them
with education about hypertension.
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21. Absolute Contra-indications
for liver transplant

 Severe cardiopulmonary disease.
 Irreversible cerebral injury
 Sepsis or active infection
 HIV/AIDS
 Extra-hepatic malignancy
 Active alcohol or drug usage
 Psychosocial issues
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22. HIV in USA

 HIV Incidence: About 50,000 new HIV infections per
year. African Americans continue to be
disproportionately affected.
 HIV prevalence: More than 1.1 million people in US
are living with HIV infection, and almost 1 in 6
(15.8%) are unaware of their infection.
 Mortality: Approximately 636,000 people in US with
an AIDS diagnosis died each year.
Incidence Prevalence Mortality
50,000 1.8 million > 650,000
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23. Summary

 Universal health coverage in USA.
 Health policy in USA.
 Cultural characteristic of US society.
 Cardiovascular risk factors and strategies to counter
these risks.
 Absolute contra-indications of liver transplantation.
 Current situation of HIV in USA.
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24. References

 Alqahtani SA, Larson AM. Adult liver transplantation in the USA.
Current Opinion in Gastroenterology. 2011; 27: 240–247
 http://www.cdc.gov/heartdisease/facts.htm
 http://www.hsph.harvard.edu/nutritionsource/an-epidemic-of-
obesity/
 http://www.clearlycultural.com/geert-hofstede-cultural-dimensions/
individualism/
 http://www.via-web.de/individualism-versus-collectivism/
 http://gbr.pepperdine.edu/2010/08/to-tell-or-not-to-tell/
 http://www.huffingtonpost.com/2013/10/03/health-care-costs-
_n_3998425.html
 http://www.who.int/countries/usa/en/
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25. 
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