Health care in the USA

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Health and Health Care Systems in the USA

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  • We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative.
    About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
  • Health care in the USA

    1. 1. Population Health in the USA
    2. 2. Health Spending as % of GDP
    3. 3. Health Spending as % of GDP 16 12 $(int) 8 4 0 USA Canada Mexico Cuba UK $int
    4. 4. Health Spending as % of GDP 16 15.4 12 $(int) 8 4 0 USA Canada Mexico Cuba UK $int
    5. 5. Health Spending as % of GDP 16 15.4 12 9.8 $(int) 8 4 0 USA Canada Mexico Cuba UK $int
    6. 6. Health Spending as % of GDP 16 15.4 12 9.8 $(int) 8 6.5 4 0 USA Canada Mexico Cuba UK $int
    7. 7. Health Spending as % of GDP 16 15.4 12 9.8 $(int) 8 6.5 6.3 4 0 USA Canada Mexico Cuba UK $int
    8. 8. Health Spending as % of GDP 16 15.4 12 9.8 $(int) 8 8.1 6.5 6.3 4 0 USA Canada Mexico Cuba UK $int
    9. 9. Total per capita expenditure on Health
    10. 10. Total per capita expenditure on Health 7,000 5,250 $(int) 3,500 1,750 0 USA Canada Mexico Cuba UK $int
    11. 11. Total per capita expenditure on Health 7,000 6,096 5,250 $(int) 3,500 1,750 0 USA Canada Mexico Cuba UK $int
    12. 12. Total per capita expenditure on Health 7,000 6,096 5,250 $(int) 3,500 3,173 1,750 0 USA Canada Mexico Cuba UK $int
    13. 13. Total per capita expenditure on Health 7,000 6,096 5,250 $(int) 3,500 3,173 1,750 655 0 USA Canada Mexico Cuba UK $int
    14. 14. Total per capita expenditure on Health 7,000 6,096 5,250 $(int) 3,500 3,173 1,750 655 0 229 USA Canada Mexico Cuba UK $int
    15. 15. Total per capita expenditure on Health 7,000 6,096 5,250 $(int) 3,500 3,173 2,560 1,750 655 0 229 USA Canada Mexico Cuba UK $int
    16. 16. Life expectancy
    17. 17. Life expectancy 81.00 80 81 78 79 77 76 75 75 75 72 60.75 40.50 20.25 0 M F M F M F M F M F USA Canada Mexico Cuba UK
    18. 18. Under 5 Mortality
    19. 19. Under 5 Mortality 30.0 22.5 21.1 15.0 7.5 7.9 6.8 5.9 0 USA Canada Mexico Cuba per 1,000 lb
    20. 20. Adult Mortality Rate (aged 15-60 per 1,000)
    21. 21. Adult Mortality Rate (aged 15-60 per 1,000) 200 162 150 137 128 100 101 90 94 81 83 62 50 56 0 M F M F M F M F M F USA Canada Mexico Cuba UK
    22. 22. Ideology and Culture
    23. 23. Ideology and Culture Libertarian Individualism
    24. 24. Ideology and Culture Libertarian Individualism Conservative
    25. 25. Ideology and Culture Libertarian Individualism Conservative National Identity
    26. 26. Ideology and Culture Libertarian Individualism Conservative Ethnic and Cultural Origins National Identity
    27. 27. Ideology and Culture Libertarian Individualism Conservative Ethnic and Cultural Origins National Identity National Legislation- Federal
    28. 28. Ideology and Culture Libertarian Individualism Conservative Ethnic and Cultural Origins National Identity Local Legislation- State National Legislation- Federal
    29. 29. Ideology and Culture Libertarian Individualism Conservative Ethnic and Cultural Origins National Identity Local Legislation- State National Legislation- Federal Influence of Religious Right
    30. 30. Ideology and Culture Libertarian Individualism Conservative Ethnic and Cultural Origins National Identity Local Legislation- State National Legislation- Federal Influence of Religious Separation of Religion and State Right
    31. 31. Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2006 (*BMI ≥30, or about 30 lbs. overweight for 5’4” person) 1990 1998 2006 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: CDC Behavioral Risk Factor Surveillance System.
    32. 32. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Behavioral Risk Factor Surveillance System, CDC.
    33. 33. Diabetes 20.8 Million (7%) Americans are diabetic 54 Million Americans are ‘pre diabetic’ American Indians (18%) Non Hispanic Blacks (16%) Hispanic/Latino (14%) Non Hispanic Whites (8%)
    34. 34. Cortland County, NY.
    35. 35. Cortland County, NY.
    36. 36. Cortland County, NY.
    37. 37. Rural Experiences
    38. 38. Social Indicators Teen preg. Child Abuse Calls
    39. 39. Social Indicators Teen preg. Child Abuse Calls 40 30 Per 1000 pop 20 10 0 Cortland NY State
    40. 40. Social Indicators Teen preg. Child Abuse Calls 40 40.0 30 Per 1000 pop 20 18.3 10 0 Cortland NY State
    41. 41. Social Indicators Teen preg. Child Abuse Calls 40 40.0 30 Per 1000 pop 20 22.1 18.3 10 9.1 0 Cortland NY State
    42. 42. Drunk Driving DWI arrests Under 20 DWI
    43. 43. Drunk Driving DWI arrests Under 20 DWI 60 45 Per 10,000 30 15 0 Cortland NY State
    44. 44. Drunk Driving DWI arrests Under 20 DWI 60 56.2 45 Per 10,000 30 25.3 15 0 Cortland NY State
    45. 45. Drunk Driving DWI arrests Under 20 DWI 60 56.2 54.2 45 Per 10,000 30 30.9 25.3 15 0 Cortland NY State
    46. 46. Social indicators Unemployment High School Droputs
    47. 47. Social indicators Unemployment High School Droputs 6.0 4.5 3.0 % 1.5 0 Cortland NY State
    48. 48. Social indicators Unemployment High School Droputs 6.0 6 6 4.5 3.0 % 1.5 0 Cortland NY State
    49. 49. Social indicators Unemployment High School Droputs 6.0 6 6 4.5 4 3.0 % 2 1.5 0 Cortland NY State
    50. 50. Average Income
    51. 51. Average Income $50,000 $46,195 $37,500 $34,867 $25,000 $12,500 $0 Cortland NY State
    52. 52. Physical Activity Moderate 30 x 5 Vigorous 20mins x 3
    53. 53. Physical Activity Moderate 30 x 5 Vigorous 20mins x 3 70.0 52.5 35.0 17.5 0
    54. 54. Medicare
    55. 55. Medicare • Department of Health and Human Services
    56. 56. Medicare • Department of Health and Human Services • Social insurance covering 43 Million Americans
    57. 57. Medicare • Department of Health and Human Services • Social insurance covering 43 Million Americans • 65+ US citizens or permanent legal resident for 5 yrs
    58. 58. Medicare • Department of Health and Human Services • Social insurance covering 43 Million Americans • 65+ US citizens or permanent legal resident for 5 yrs • Or under 65 with permanent disability social security benefit for more than 24 months
    59. 59. Medicare • Department of Health and Human Services • Social insurance covering 43 Million Americans • 65+ US citizens or permanent legal resident for 5 yrs • Or under 65 with permanent disability social security benefit for more than 24 months • End stage renal disease, renal failure,
    60. 60. Finance
    61. 61. Finance • Payroll tax- 1.45% worker/ 1.45% employer
    62. 62. Finance • Payroll tax- 1.45% worker/ 1.45% employer • Total medicare spending $440 billion (2007) 16% of all federal spending
    63. 63. Hospital care
    64. 64. Hospital care • At least 3 days (midnights) not counting discharge day
    65. 65. Hospital care • At least 3 days (midnights) not counting discharge day • Nursing home stay for conditions connected to hospital stay (eg. Post surgery rehab)
    66. 66. Hospital care • At least 3 days (midnights) not counting discharge day • Nursing home stay for conditions connected to hospital stay (eg. Post surgery rehab) • Only “Skilled Care” covered for up to 100 days
    67. 67. Hospital care • At least 3 days (midnights) not counting discharge day • Nursing home stay for conditions connected to hospital stay (eg. Post surgery rehab) • Only “Skilled Care” covered for up to 100 days • First 20 days full cost
    68. 68. Hospital care • At least 3 days (midnights) not counting discharge day • Nursing home stay for conditions connected to hospital stay (eg. Post surgery rehab) • Only “Skilled Care” covered for up to 100 days • First 20 days full cost • 80 days part payment (above $128)
    69. 69. Hospital care • At least 3 days (midnights) not counting discharge day • Nursing home stay for conditions connected to hospital stay (eg. Post surgery rehab) • Only “Skilled Care” covered for up to 100 days • First 20 days full cost • 80 days part payment (above $128) • After 100 days must have a gap of 60+ days before eligible for more care support
    70. 70. Medicines and other out patient costs
    71. 71. Medicines and other out patient costs • Optional cover • Local and National Determinations of Cover • Outpatient procedures • Physician, nursing, x-ray, laboratory and other diagnostic tests • Canes, walking and mobility aids, • one pair of spectacle after cataract surgery • Oxygen for home use • Influenza and other vaccines • Blood transfusions, renal dialysis • Chemotherapy • Immunosuppresive drugs for organ transplant patients • Medications administered by a physician in the doctor’s office
    72. 72. Medicare +
    73. 73. Medicare + • Additional or alternative private medical insurance • Equivalent to medicare but may be variable in cover offered • Co payment required for many areas of health care
    74. 74. Additional costs
    75. 75. Additional costs • Hospital Cover • 10 years+ (40 quarters) contributions $233 per month • Less than 7.5 yrs (30 quarters) Contributions $423 per month • Medicines cover- $89 per months
    76. 76. Deductibles
    77. 77. Deductibles • 1- 60 days hospital care $1,024
    78. 78. Deductibles • 1- 60 days hospital care $1,024 • 61- 90 days $256 per day
    79. 79. Deductibles • 1- 60 days hospital care $1,024 • 61- 90 days $256 per day • 91- 150 days $512 per day
    80. 80. Deductibles • 1- 60 days hospital care $1,024 • 61- 90 days $256 per day • 91- 150 days $512 per day • $128 per day for skilled nursing home care 21- 100 days
    81. 81. Deductibles • 1- 60 days hospital care $1,024 • 61- 90 days $256 per day • 91- 150 days $512 per day • $128 per day for skilled nursing home care 21- 100 days • Blood deductible for first 3 units of blood unless replaced
    82. 82. Deductibles • 1- 60 days hospital care $1,024 • 61- 90 days $256 per day • 91- 150 days $512 per day • $128 per day for skilled nursing home care 21- 100 days • Blood deductible for first 3 units of blood unless replaced
    83. 83. Payments to providers
    84. 84. Payments to providers • Fixed amount per condition not actual treatment costs
    85. 85. Payments to providers • Fixed amount per condition not actual treatment costs • “Upcoding” by Physician to cover unexpected costs
    86. 86. Payments to providers • Fixed amount per condition not actual treatment costs • “Upcoding” by Physician to cover unexpected costs • Hospitals can keep money not spent on patient (cover shortfall for excess on other patients)
    87. 87. problems
    88. 88. problems • Number of workers paying contributions compared to claimants falling • Cost of treatments increasing
    89. 89. Medicaid
    90. 90. Medicaid • Joint state and federal funded entitlement programme
    91. 91. Medicaid • Joint state and federal funded entitlement programme • Low income parents, children, seniors and people with disabilities
    92. 92. Medicaid • Joint state and federal funded entitlement programme • Low income parents, children, seniors and people with disabilities • State participation is voluntary but all states currently take part
    93. 93. Medicaid • Joint state and federal funded entitlement programme • Low income parents, children, seniors and people with disabilities • State participation is voluntary but all states currently take part • Average expenditure 22% of state spending
    94. 94. Medicaid • Joint state and federal funded entitlement programme • Low income parents, children, seniors and people with disabilities • State participation is voluntary but all states currently take part • Average expenditure 22% of state spending • Covers 42.9 million Americans
    95. 95. Medicaid • Joint state and federal funded entitlement programme • Low income parents, children, seniors and people with disabilities • State participation is voluntary but all states currently take part • Average expenditure 22% of state spending • Covers 42.9 million Americans • 37% of Childbirths
    96. 96. Medicaid • Joint state and federal funded entitlement programme • Low income parents, children, seniors and people with disabilities • State participation is voluntary but all states currently take part • Average expenditure 22% of state spending • Covers 42.9 million Americans • 37% of Childbirths • 60% of nursing home care
    97. 97. Eligibility
    98. 98. Eligibility • Varies from state to state
    99. 99. Eligibility • Varies from state to state • Low income plus
    100. 100. Eligibility • Varies from state to state • Low income plus • Age
    101. 101. Eligibility • Varies from state to state • Low income plus • Age • Pregnancy
    102. 102. Eligibility • Varies from state to state • Low income plus • Age • Pregnancy • Blindness
    103. 103. Eligibility • Varies from state to state • Low income plus • Age • Pregnancy • Blindness • Disability

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