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Health Care Fund Flow

Health Care Fund Flow. Where it comes from, Where it goes. Samuel Metz, MD PNHP Portland OR Chapter Mad As Hell Doctors May 4th, 2010. What is Health Care Reform?. Universal access regardless of health, wealth, or employment Reduced cost Improved public health.

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Health Care Fund Flow

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  1. Health Care Fund Flow Where it comes from, Where it goes Samuel Metz, MD PNHP Portland OR Chapter Mad As Hell Doctors May 4th, 2010

  2. What is Health Care Reform? Universal access regardless of health, wealth, or employment Reduced cost Improved public health

  3. What makes American health care so expensive?Answers from the Physician’s Lounge End of life care Patient demand for unnecessary procedures Fee-for-service payment Unreimbursed immigrant care Defensive medicine Fraud and abuse Drug company profits Insurance company profits

  4. Insurance: Unregulated vs Regulated Unregulated: Young and healthy pay low prices for comprehensive policies. Old and sick pay high prices for limited policies. Profit made on financing health care. Regulated: Everyone pays the same price for the same policy. No profit on financing health care (profit may be made on providing health care) :

  5. What’s the Point? Before we improve how we practice, we must improve how we pay.

  6. Health Care Money: Flow In, Flow Out Numbers in billions $2,400

  7. Health Care Money: Flow In, Flow Out Numbers in billions $2,400 $1,080 Government Insurance: Employer $672 Insurance: Individual $288 $360 Out of Pocket

  8. Health Care Money: Flow In, Flow Out Numbers in billions $2,400 $1,080 Government Insurance: Employer $672 Hospital: $620 Insurance: Individual $288 Medical care for citizens $1,666 Non-MD Fees: $405 $360 Out of Pocket Medication: $261 Home & Residential: $220 Physicians: $160

  9. Health Care Money: Flow In, Flow Out Numbers in billions $2,400 $1,080 Government Government overhead: $72 Research: $139 Fraud: $77 Defensive medicine: $60 Immigrant care: $40 Insurance: Employer $672 Hospital: $620 Insurance: Individual $288 Medical care for citizens $1,666 Non-MD Fees: $405 $360 Out of Pocket Medication: $261 Home & Residential: $220 Physicians: $160

  10. Health Care Money: Flow In, Flow Out Numbers in billions Private insurance: $146 $2,400 Private Overhead $350 Hospital: $94 Physician: $61 Home: $32 Employer: $17 $1,080 Government Government overhead: $72 Research: $139 Fraud: $77 Defensive medicine: $60 Immigrant care: $40 Insurance: Employer $672 Hospital: $620 Insurance: Individual $288 Medical care for citizens $1,666 Non-MD Fees: $405 $360 Out of Pocket Medication: $261 Home & Residential: $220 Physicians: $160

  11. Sources: Woolhandler S, Costs of health care administration in the United States and Canada, NEJM 2003;349:768-772; Institute for Health and Socio-Economic Policy. Single Payer/Medicare for All: An economic stimulus plan for the nation. 2009; National Health Care Anti-Fraud Association (NHCAA); Leonhardt D. Medical Malpractice System Breeds More Waste. New York Times, September 23, 2009; Mohanty . Health Care Expenditures of Immigrants in the United States. American Journal of Public Health, 200595, No. 8

  12. US Federal Budget, http://www.whitehouse.gov/omb/budget/fy2010/assets/hist04z1.xls; U.S. Department of Education, National Center for Education Statistics. (2009).Digest of Education Statistics, 2008; Kaiser Family Foundation, StateHealthFacts.org http://www.statehealthfacts.org/comparemaptable.jsp?ind=177&cat=4; Center for Defense information, quoted at http://www.infoplease.com/ipa/A0933935.html

  13. Carol J. Simon, Julie Wolcott, Paul Hogan*, The Lewin Group. Can We Reduce Health Care Spending? October 26, 2009. http://www.lewin.com/content/publications/LewinReport-CostDrivers.pdf The Health Care For All Californians Act: Cost &Economic Impacts Analysis. JF Sheils, RA Haught, Lewin Group, January 19, 2005

  14. Funds in, funds out:What did we learn? 45% of health care funds flow through government (“socialized medicine”). Unregulated private insurance is the most expensive method of funding health care in the world. We can provide universal cost-effective health care with money we already spend.

  15. Beware of what you promise… “…if you like your health care plan, you keep your health care plan.” Protecting the right to keep our unregulated private insurance policies costs us $350 billion each year Is it worth it?

  16. What’s the Point? Before we improve how we practice, we must improve how we pay.

  17. Universal Laws of Health Care SystemsTsung-Mei Cheng, economist No matter how good the care, people complain about it. No matter how much you spend, doctors and hospitals want more. The last reform always fails.

  18. What can Americans do? “I love change, except the part about doing things differently.” "In the United States today, we give you all the care you can afford, whether or not you need it, as opposed to all the care you need, whether or not you can afford it." Arthur Kellerman, M.D., Associate Dean, Emory University School of Medicine “First we enroll everyone in our dysfunctional, barbaric medical system. Then everyone has a stake in making it better.”

  19. How do they do it? Single payer: public payer, public providers (England, similar to our VA system) Single payer: public payer, private providers (Canada, on which our Medicare is based) Single payer: private payer, private providers (Taiwan, similar to union medical trusts) Employer based non-profit insurance (France) Individual based non-profit insurance (Germany)

  20. What do they have in common? Everyone is in a single risk pool with a single schedule of benefits Minimal cost-sharing to increase primary care use, reduce tertiary care use. Financing through regulated, non-profit agencies

  21. References Costs of private insurance: Woolhandler S, et al. Costs of Health Care Administration in the United States and Canada. New England Journal of Medicine. 2003; 349:768-775. http://content.nejm.org/cgi/content/full/349/8/801. (Dr. Woolhandler’s article lists these figures per capita. I multiplied each by 300 million.) Casalino LP, et al. What Does It Cost Physician Practices to Interact with Health Insurance Plans? Health Affairs Web Exclusive, May 14, 2009, w533–w543 http://content.healthaffairs.org/cgi/content/abstract/28/4/w533?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Casalino&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT Immigrant care: Mohanty SA, Steffie Woolhandler S, Himmelstein DU, Pati S, Carrasquillo O, Bor DH. Health Care Expenditures of Immigrants in the United States: A Nationally Representative Analysis. American Journal of Public Health, 2005, Vol 95, No. 8, August Fraud and abuse: Inglehart JK. Finding Money for Health Care Reform — Rooting Out Waste, Fraud, and Abuse. New Engl J Med 2009, website 10.1056/nejmp0904854 National Health Care Anti-Fraud Association (NHCAA). http://www.nhcaa.org/eweb/DynamicPage.aspx?webcode=anti_fraud_resource_centr&wpscode=TheProblemOfHCFraud Defensive medicine: Leonhardt D. Medical Malpractice System Breeds More Waste. New York Times, September 23, 2009, http://www.nytimes.com/2009/09/23/business/economy/23leonhardt.html?_r=1&emc=tnt&tntemail1=yals Relman A. Second opinion: Rescuing America’s health care. Public Affairs, New York NY, 2007, p.91-2 Government overhead: Relman A. The Health Reform We Need & Are Not Getting. New York Review of Books, 2 July 2009,http://www.nybooks.com/articles/22798?email Institute for Health and Socio-Economic Policy. Single Payer/Medicare for All: An economic stimulus plan for the nation. 2009. from the California Nurses Association. http://www.calnurses.org/research/pdfs/ihsp_sp_economic_study_2009.pdf

  22. References Medical research: Institute for Health and Socio-Economic Policy. Single Payer/Medicare for All: An economic stimulus plan for the nation. 2009. from the California Nurses Association. http://www.calnurses.org/research/pdfs/ihsp_sp_economic_study_2009.pdf Breakdown of medical spending: Kaiser Family Foundation Slides, "Costs / Insurance" slide # 77 of 141 - http://facts.kff.org/results.aspx?view=slides&topic=3&start=1&num=4 American Association of Medical Colleges. 2009 State Physician Workforce Data Book, Center for Workforce Studies, November 2009. http://www.aamc.org/workforce/statedatabook/statedata2009.pdf Institute for Health and Socio-Economic Policy. Single Payer/Medicare for All: An economic stimulus plan for the nation. 2009. from the California Nurses Association. http://www.calnurses.org/research/pdfs/ihsp_sp_economic_study_2009.pdf Comparative spending, government expenditures: US Federal Budget, http://www.whitehouse.gov/omb/budget/fy2010/assets/hist04z1.xls; US spending on primary and secondary education: U.S. Department of Education, National Center for Education Statistics. (2009).Digest of Education Statistics, 2008; Medicaid expenditures: Kaiser Family Foundation, StateHealthFacts.org http://www.statehealthfacts.org/comparemaptable.jsp?ind=177&cat=4; War in Afghanistan: Center for Defense information, quoted at http://www.infoplease.com/ipa/A0933935.html Interest on national debt: US Treasury, http://www.treasurydirect.gov/govt/reports/ir/ir_expense.htm Obesity, Tobacco, and Alcohol: Carol J. Simon, Julie Wolcott, Paul Hogan, The Lewin Group. Can We Reduce Health Care Spending? Searching for Low-Hanging Fruit in the Garden of Health System Reform, October 26, 2009. http://www.lewin.com/content/publications/LewinReport-CostDrivers.pdf

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