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Healthcare USA

Medical Care

Define Health

WHO- state of complete physical, mental and social well-being, not merely the absence of disease
IOM- a state of well-being and the capability to function in the face of changing circumstances(social and personal resources and physical capabilities)
SAEM- state of physical and mental well-being that facilitates the achievement of individual and societal goals (Society for Academic Emergency Medicine)

Indicators of Health

Infant Mortality Rate
Life Expectancy
Rates of Disease
Causes of Death and Disability

Define Healthcare

The prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical and allied health professions. (Medical Dictionary)
WHO- “to ensure that all people obtain the health services they need without suffering financial hardship when paying for them.”

Define Health Care

A healthcare system is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.
The enrolled population enters into a contract with the organization, agreeing to pay, or have paid on their behalf, a fixed sum, in return for which the HMO makes available the health care personnel, facilities, and services that the population may require.

Implicitly, nations must design and develop health systems in accordance with their needs and resources, although virtually all health systems have primary healthcare and public health measures.
White F (2015). "Primary health care and public health: foundations of universal health systems". Med Princ Pract. 24: 103–116. doi:10.1159/000370197.

Indicators for health care

% GDP
% Government (Public) Expense
Per capita
Administration Costs
Resources-
Pharmaceutical,
Physicians and Nurses and other providers
Medical Technology
Hospitals, clinics, rehab centers, nursing homes

Where USA ranks in World

World Health Report 2000
“A healthcare system should strive to achieve the highest possible average level of health with the fewest disparities among individuals and groups”
USA ranked 37 out of 191 countries
USA ranked #1 in spending

Table 1.23

Health Care Spending Per Capita by OECD Country, 1960-1999

*Expenditures in U.S. dollars using purchasing power parity rates.

**For some years, no data was available.

***1998 data was used because 1999 was not available.

Note: The data is arrayed by expenditure levels for 1999. The medians include all OECD countries.

Source: OECD Health Data 2002.

U.S. spending is significantly higher than other OECD countries.

Median: $64 $146 $591 $1,270 $1,798

Total Health Expenditure per Capita, U.S. and Selected Countries, 2008

Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011). Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted.

Table 1.25

Percent of GDP Spent on Health Care by OECD Country, 1960-1999

*For some years, no data was available.

**1997 data was used because 1999 was not available.

Note: The data is arrayed by spending growth from 1990 to 1999. The medians include all OECD countries.

Source: OECD Health Data 2002.

The U.S. has had a higher share of GDP spent on health than the OECD median for
the past four decades.

Median: 3.9% 5.1% 6.8% 7.5% 7.9%

Table 1.27

National Health Spending by Source of Funds by OECD Country, 2000

Source: OECD Health Data 2002 2nd ed.

Source of funding varies significantly by country. For instance, out-of-pocket spending ranges from 10% to 44% of health spending with the U.S. at about the average.

Where USA ranks in OECD World

USA ranked lowest in health indicators:
Infant mortality
Low birth weight percentages
Years of potential life lost

Where USA ranks in World

After WWII Americans were known as the tallest people…now they are known as the fattest.
CIA - The World Factbook - Guide to Country Profiles

Table 1.34

Male and Female Life Expectancy at Birth by OECD Country,
1960-1999

Note: Data are arrayed by male life expectancy; countries are kept together. The medians include all OECD countries.

Source: OECD Health Data 2002.

Male

Female

Median = 67.2 70.0 74.6

Median = 72.5 76.6 80.6

USA compared to other countries

Infant Mortality Rate, USA by Race
http://mchb.hrsa.gov/chusa03/pages/status.htm#infant

The USA spends more money on healthcare
But does not have the best health indicators!

History of USA Healthcare System

Golden Age – 1950’s – 1980’s
Fee for service: doctors, hospitals and clinics provide services and bill insurance companies.
Providers are rewarded for providing more and more services
Problem of unnecessary treatments and waste

History

After Healthcare costs skyrocketed, 1980’s – 1990’s, “managed care” philosophy put on the brakes for spending
HMO-Health Maintenance Org.
MCO- Managed Care Organizations
PPO- Preferred Provider Org.

US Healthcare (2008)

Employers provide 60% of health insurance (benefits package)
Emloyees may pay premiums or deductibles and co-pays
Doctors, hospitals, clinics and providers are all privately owned.

Health Coverage, total population

Employer 54%
Individual 5%
Medicaid 13%
Medicare 12%
Other Public 1%
Uninsured 16%

US Healthcare (2008)

45 million uninsured, 8.5 million children
Working poor, no insurance
1/4 employers do not provide insurance
Unemployed
Uninsurable
18,000 people die each year because they lack insurance (example: women with breast cancer 50% more likely to die without insurance)

Putting Off Care Because of Cost

Relied on home remedies or over the counter drugs instead of seeing a doctor

Skipped dental care or checkups

Put off or postponed getting health care you needed

Skipped recommended medical test or treatment

Not filled a prescription for a medicine

In the past 12 months, have you or another family member living in your household… because of the COST, or not?

Did ANY of the above

Percent saying “yes”

Cut pills in half or skipped doses of medicine

Had problems getting mental health care

Source: Kaiser Family Foundation Health Tracking Poll (conducted November 5-12, 2009)

Current US Healthcare

Government is involved only partially
Fills the gap where private care stops
HHS, FDA, CDC, and many regulatory agencies--few direct services
State and County Health Departments
Vaccines, Infectious diseases, Prenatal care
Some hospital and clinic services especially for mental health

Government Insurance :Medicare / Medicaid

Center for Medicare and Medicaid (CMS)
Established in 1965 for elderly and low income
Medicare: for citizens over 65
Federal hospital and doctor insurance
Some premiums due
Does not cover prescription drugs (until 2006 under the Medicare Modernization Act)
Medicaid
Cost covered by state and federal govt
States determine extent of benefits
Eligibility determined by income
In Oregon - Oregon Health Plan

Costs

14% of USA GDP per year (includes all health expenditures, public and private)
45% govt., 55% private
17% of all government expenditures ($2.56 trillion)
33% is Medicare and Medicaid
https://www.cia.gov/cia/publications/factbook/index.html

USA Revenues and Expenditures

Year	Revenues	Expenditures
2006	2,409	2,665
2008	2,524	2,978
2009	1,914	3,615
2011	2,465	3,649
2012	2,449	3,538

Institute of Medicine 2004 Report

“ The United State should adopt universal health coverage by 2010 to avoid needless deaths and substantial monetary costs to society”
Economic costs for premature deaths
Poorer health among the poor costs more in future
Hospitals uncompensated for care, close

Institute of Medicine 2004 Report

Recommendations
Single payer system administered by the government
Combination government and employers to provide insurance coverage
Tax credits for individuals to purchase insurance
http://www.iom.edu/

Resources

Institute for Healthcare Improvement http://www.ihi.org/ihi
Health and Humans Services: Hospital Compare www. hospitalcompare . hhs .gov
Health Resources and Services www.hrsa.gov/
Health Information: http://www.healthfinder.gov/

$14

$74

$89

$26

$48

$87

$64

$53

$72

$109

$90

$136

$144

$83

$144

$270

$130

$151

$240

$159

$130

$206

$260

$223

$288

$349

$328

$444

$850

$522

$658

$662

$577

$701

$710

$824

$881

$1,058

$813

$972

$1,492

$1,083

$1,321

$1,300

$1,206

$1,245

$1,517

$1,676

$1,600

$1,836

$2,739

$1,469

$1,666

$1,748

$1,844

$1,882

$2,058$2,061

$2,144

$2,226

$2,428

$2,451

$3,080

$4,373

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

Spain

United Kingdom

Sweden***

Japan

Italy**

Australia***

Austria

Belgium

France

Canada

Germany

Switzerland

United States

19601970198019901999

5.1

4.9

5.4

4.3

4.5

3.6

1.5

3.9

4.5

6.9

5.6

6.3

6.1

5.6

5.3

6.9

5.1

3.6

4.5

8.7

7.6

8.8

7.1

6.6

7.6

9.1

5.4

6.4

5.6

11.9

8.5

8.7

7.5

7.8

7.1

8.5

6.6

5.9

10.3

8.7

8.5

10.7

9.2

8.1

7.9

7.8

7.7

7.4

7.1

United Kingdom

Japan

Spain

Italy*

Sweden**

Austria

Australia**

Greece*

Canada

Germany*,**Switzerland

United States

Percent

19601970198019901999

66%

29%

78%

70%

82%

27%

60%

13%

74%

64%

11%

74%

69%

10%

15%

69%

43%

15%

63%

33%

13%

35%

11%

10%

11%

15%15%

16%16%

17%

19%

21%

23%

26%

44%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

France

Germany

Ireland

United StatesNew Zealand

Canada (1999)

Denmark

Japan (1999)

Austria

Finland

Hungary

Italy

Spain (1999)

Korea (1999)

Percent of Total Health Expenditure

Out-of-Pocket

Payments

All Other Private

Funds

Private Insurance

Social Security

Schemes

General Government,

Excl. Social Security

75.1

77.3

78.1

79.4

81.8

81.9

82.5

59.5

73.4

74.4

70.2

73.6

74.9

73.9

73.1

70.1

73.9

77.3

78.8

78.4

77.4

78.1

72.7

78.8

0306090

Hungary

Mexico

Czech Republic

Denmark

United States

Australia

Sweden

France

Japan

Year

196019801999

65.9

65.5

66.3

72.8

71.4

74.2

73.9

76.2

71.2

70.4

67.9

56.2

66.6

67.9

65.3

72.8

71.2

66.8

70.2

73.4

77.1

0306090

Hungary

Mexico

Czech Republic

Denmark

United States

Australia

Sweden

France

Japan

Year

196019801999

17%

22%

26%

30%

34%

53%