Healthcare USA

1. Healthcare USA Medical Care

2. 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)

3. Indicators of Health • Infant Mortality Rate • Life Expectancy • Rates of Disease • Causes of Death and Disability

4. 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.”

5. 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 PrincPract. 24: 103–116. doi:10.1159/000370197.

6. 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

7. 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

8. Table 1.23 Health Care Spending Per Capita by OECD Country, 1960-1999 U.S. spending is significantly higher than other OECD countries. Median: $64 $146 $591 $1,270 $1,798 *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.

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

11. Table 1.25 Percent of GDP Spent on Health Care by OECD Country, 1960-1999 The U.S. has had a higher share of GDP spent on health than the OECD median forthe past four decades. Median: 3.9% 5.1% 6.8% 7.5% 7.9% *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.

12. Table 1.27 National Health Spending by Source of Funds by OECD Country, 2000 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. Source: OECD Health Data 2002 2nd ed.

13. Where USA ranks in OECD World • USA ranked lowest in health indicators: • Infant mortality • Low birth weight percentages • Years of potential life lost

14. 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

15. Table 1.34 Male and Female Life Expectancy at Birth by OECD Country,1960-1999 Male Female Median = 67.2 70.0 74.6 Median = 72.5 76.6 80.6 Note: Data are arrayed by male life expectancy; countries are kept together. The medians include all OECD countries. Source: OECD Health Data 2002.

17. USA compared to other countries

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

21. The USA spends more money on healthcareBut does not have the best health indicators!

22. 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

23. 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.

24. 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.

25. Health Coverage, total population • Employer 54%   • Individual 5%   • Medicaid 13%   • Medicare 12%   • Other Public 1%   • Uninsured 16% 

26. 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)

28. Putting Off Care Because of Cost In the past 12 months, have you or another family member living in your household… because of the COST, or not? Percent saying “yes” 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 Not filled a prescription for a medicine Skipped recommended medical test or treatment Cut pills in half or skipped doses of medicine Had problems getting mental health care Did ANY of the above Source: Kaiser Family Foundation Health Tracking Poll (conducted November 5-12, 2009)

29. 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

30. 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

31. 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

32. USA Revenues and Expenditures

34. 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

35. 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/

36. 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/