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Int’l Models of Coverage

Int’l Models of Coverage. ...or, what Monty Python can teach Barack Obama about health care reform. Jonathan Cohn Senior Editor, The New Republic. 15. THE COMMONWEALTH FUND. Cost-Related Access Problems. Base: Adults with any chronic condition.

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Int’l Models of Coverage

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  1. Int’l Models of Coverage ...or, what Monty Python can teach Barack Obama about health care reform Jonathan Cohn Senior Editor, The New Republic

  2. 15 THE COMMONWEALTH FUND Cost-Related Access Problems Base: Adults with any chronic condition Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

  3. Spending as % GDP

  4. Doctor Visits Source: OECD

  5. 8 THE COMMONWEALTH FUND Coordinated Care Base: Adults with any chronic condition Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

  6. 10 THE COMMONWEALTH FUND Basic Diabetes Care Base: Adults with diabetes Percent received all four diabetes services* * Hemoglobin A1c checked in past six months; feet examined for sores or irritations in past year; eye exam for diabetes in past year; and cholesterol checked in past year. Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

  7. Waiting Times Source: McKinsey Global Institute http://www.mckinsey.com/mgi/rp/healthcare/accounting_cost_healthcare.asp

  8. 5 THE COMMONWEALTH FUND Waiting Times, Cont’d Base: Adults with any chronic condition (Percent) Same-day appointment 6+ days wait or never able to get appointment Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

  9. 6 THE COMMONWEALTH FUND Waiting Times, Cont’d Again Base: Adults with any chronic condition who needed to see a specialist in past 2 years (Percent) Less than 4 weeks Two months or longer Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

  10. 7 THE COMMONWEALTH FUND Urgent Care Issues Base: Adults with any chronic condition who needed after-hours care Percent reported very/somewhat difficult getting care on nights, weekends, or holidays without going to ER 62 60 56 56 44 39 36 30 Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

  11. CT Scanners Source: OECD

  12. Ortho Procedures Source: McKinsey Global Institute http://www.mckinsey.com/mgi/rp/healthcare/accounting_cost_healthcare.asp

  13. Life Expectancy Source: OECD

  14. Life Expectancy After 65 Source: OECD

  15. Potential Years of Life Lost Source: OECD

  16. Cancer Survival, Part 1 Source: Coleman et al, Lancet Oncology

  17. Cancer Survival, Part 2 Source: Coleman et al, Lancet Oncology

  18. Cancer Survival, Part 3 Source: Gerard Anderson, JHU

  19. 14 THE COMMONWEALTH FUND Perceptions of Health Systems Base: Adults with any chronic condition Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

  20. OH, CANADA Pure single-payer (or pretty damn close to it) • The Bad • Waiting times • Rigidity • The Good • Financial protection • Equity • Primary care • Continuity of care

  21. ARS Question 13: Follow-up Overall, how do you believe the healthcare system in Canada compares to the United States system in cost, coverage and care? A. Much better B. Somewhat better C. Same as US D. Somewhat worse E. Much worse

  22. LONDON FOG Nationalized medicine with a stiff upper lip • The Bad • Waiting times • Speciality Care • The Good • Financial protection • Equity • Primary Care • NICE is nice

  23. ARS Question 14: Follow-up Overall, how do you believe the healthcare system in the United Kingdom compares to the United States system in cost, coverage and care? A. Much better B. Somewhat better C. Same as US D. Somewhat worse E. Much worse

  24. ARS Question 15: Follow-up Do you believe that the United States should adopt a similar institute for studying the comparative effectiveness of treatments/care? A. Yes B. Yes, but US system should not limit care as much as the UK. C. No

  25. DUTCH TREAT A health insurance market that works. (We think.) • The Good • Financial protection • Equity with choice • Primary care • Continuity of care • Quality incentives • After-hours care • The Bad • Mandate gaps • Worries about risk selection

  26. ARS Question 16: Follow-up Overall, how do you believe the healthcare system in Holland compares to the United States system in cost, coverage and care? A. Much better B. Somewhat better C. Same as US D. Somewhat worse C. Much worse

  27. ARS Question 17: Follow-up The United States should adopt quality and efficiency incentives similar to Holland? A. Strongly Agree B. Somewhat Agree C. Somewhat Disagree D. Strongly Disagree

  28. FRENCH KISS If Medicare were served with a fine Bordeaux • The Good • Financial protection • Equity plus choice • Primary care • High-tech care • Choice and convenience • The Bad • Overtreatment • Poor continuity • Rural/urban disparities • Quality incentives

  29. ARS Question 18: Follow-up Overall, how do you believe the healthcare system in France compares to the United States system in cost, coverage and care? A. Much better B. Somewhat better C. Same as US D. Somewhat worse E. Much worse

  30. ARS Question 19: Follow-up The United States should adopt a system similar to France, which is very close to the Medicare system in the United States? A. Strongly Agree B. Somewhat Agree C. Somewhat Disagree D. Strongly Disagree

  31. HEALTH REFORM, IMAGINED I.e., if Jonathan were king • Key elements • Insurance structure and financing levels of France • Quality incentives and care management of Holland • Comparative effectiveness of Britain • Provider choice of Canada • Public research funding and institutions of U.S.

  32. HEALTH REFORM, REALITY I.e., because the filibuster is king • Key elements of Obama/Baucus/Kennedy • Retain employer-sponsored insurance • Pooling for small business and individuals • Public plan option • IT, comparative effectiveness, incentives for quality • Financed by taxes + employer mandate • Individual mandate maybeKey elements of Wyden/Bennett • Transition from employer to individual insurance • Pooling for everybody • No public plan; private insurers as regulated utility • Individual mandate for sure

  33. ARS Question 21: Follow-up After hearing about consensus plan efforts at the federal level, do you believe they are headed in the right direction? A. Yes B. No, not extensive enough C. No, this is the wrong direction D. Unclear, not enough information

  34. A Word From Our Sponsor (Er, Speaker) To read the book Sick, visit www.sickthebook.com To follow the health care debate, visit www.tnr.com/thetreatment To contact the speaker, e-mail jcohn@tnr.com

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