HCA RESPONSE 2

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I currently work as a hospitalist in Southern California, San Diego.  The dominant healthcare systems in this region are Kaiser Permanente Health System, Scripps Health System, Sharp Health System, and University of California San Diego Health System.  Per US News Health Care, University of California San Diego Health System is ranked first in the region1.  For inpatient medical management, each health system has their own pool of insured patients and attempts to keep their patients within their own health system.  

For my hospital, Scripps Encinitas is a community hospital that is a part of a larger healthcare system.  It has 194 beds composed of ICU level, Step-down level, Labor and Delivery level, telemetry level, and medical–surgical level2.  My conclusion about Scripps Encinitas is that it is an average community hospital.  It is not ranked nationally as it is more of a community hospital1.  Per the Dartmouth Atlas of Health Care, Medicare average expenditure for inpatient care in the last two years of life is $38,313 which is much less in spending cost than the average for San Diego area of $84,8933.  12.2% of all medical patient discharges get re-admitted within 30-days for 20123.  56% of medical patient discharges have a follow-up with a primary care physician within 2 weeks3.  In comparison to San Diego group data, Scripps Encinitas was better than the area hospitals on 30-days medical readmission rate of 15.7% in 20123.  However this distinction seems to be lost by 2016.  From the Commonwealth Fund, Scripps Encinitas’ readmission rate is within the average for the area of San Diego and on the national level4.  The 30 day risk-adjusted medical readmission average for San Diego is 12.5% and for national level is 12.8% in 20164.  The readmission rate finding is consistent with report from US News that Scripps Encinitas has an average readmission rate for medical conditions such as chronic obstructive pulmonary disease and heart failure2.   

In comparison, the United Kingdom (UK) health care spending per capita in 2014 is $3,9355.  The United Kingdom spends about 9.1% of Gross Domestic Product on health care6.   The infant mortality in the United Kingdom per 1000 live births in 2016 is 47.   United Kingdom’s average life expectancy is 81 years8.  The United Kingdom’s 2014 fertility rate per female is 1.8 birth per woman9.

 For the California region, the average annual healthcare spending per capita is $6,23810.  The infant mortality for San Diego is 3.9 per 1000 live births, average life expectancy is 80.1 years, with a fertility rate of 2.4 births per woman11.

 San Diego has access to all the advantages that modern medicine offers.  Typical to the US, San Diego healthcare expenditure is in line with the national average.  The US spend more of healthcare per capita than the UK.  The UK system is said to focus more on preventive health and cost is managed.  Furthermore, end of life cost are noted to be more in the US than in the UK.  Otherwise, both San Diego are compares well with the UK in life expectancy and infant mortality.  San Diego however does have a high fertility rate- owed to the large Hispanic population with a cultural propensity for having larger families to explain the difference in fertility rates. 

 Given that the UK is a single-payer system, there are pros and cons associated with this model.  The advantages include coverage for all.  Everyone in theory has equal access to the same health care.  Cost in theory is not a burden for the individual and more manageable for the society as a whole.  The problem with single payer system is the wait time for certain specific and specialize care that require prior authorization and a delay may occur.  Another problem with the single payer system is an emphasis on managed care- this is exemplified especially in the cost of care in the last two years of life between the two systems- UK vs US. 

References:

1. “Best Hospitals in San Diego. Calif.” U.S. News. Health Care. n.d. web. 23 Jul. 2016. http://health.usnews.com/best-hospitals/area/san-diego-ca

 2. “Scripps Memorial Hospital-Encinitas”. U.S. News. Health Care. n.d. web. 23 Jul. 2016. http://health.usnews.com/best-hospitals/area/ca/scripps-memorial-hospital-encinitas-6930648

3. “Darthmouth Atlas of Healthcare”. The Trustees of Dartmouth College. n.d. web. 23 Jul. 2016. http://www.dartmouthatlas.org

4. “Health System Data Center”. The Commonwealth Fund. n.d. web. 23 Jul. 2016. http://datacenter.commonwealthfund.org/scorecard/local/94/san-diego/

5. “Health Spending Per Capita”. The World Bank. 2016. Web. 23 Jul. 2016. http://data.worldbank.org/indicator/SH.XPD.PCAP

6. “Health Expenditure, Total (% of GDP)”. The World Bank. 2016. Web. 23 Jul. 2016. http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

7. “Mortality Rate, Infant (Per 1,000 Live Births)”. The World Bank. 2016. Web. 23 Jul. 2016. http://data.worldbank.org/indicator/SP.DYN.IMRT.IN

8. “Life Expectancy at Birth, Total (Years)”. The World Bank. 2016. Web. 23 Jul. 2016. http://data.worldbank.org/indicator/SP.DYN.LE00.IN

9. “Fertility Rate, Total (Births Per Woman)”. The World Bank. 2016. Web. 23 Jul. 2016. http://data.worldbank.org/indicator/SP.DYN.TFRT.IN

10. “Healthcare Expenditures Per Capita by State of Residence”. Kaiser Family Foundation. n.d. web. 23 Jul. 2016. http://kff.org/other/state-indicator/health-spending-per-capita/

11. Alvarez, Jose. “Infant Death in San Diego Decline.” County News Center. San Diego County. 16 Jan. 2014. Web. 23 Jul. 2016. http://www.countynewscenter.com/infant-deaths-san-diego-decline/

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