The US Healthcare System

1. The US Healthcare System Impact on Equity, Efficiency and Effectiveness

2. BASIC SERVICE COMPONENTS OF A HEALTH CARE SYSTEM • Public Health (Including Health Promotion and Disease Prevention) • Emergency medical services (including transportation) • Ambulatory care for simple/limited conditions • Acute and community hospitals and medical centers • Long-term care (either in-home or institutional care) • Mental Health Services (both inpatient and ambulatory) • Rehabilitation services (both inpatient and ambulatory) • Dental services • Pharmaceuticals/supplies/medical devices and equipment

3. Need vs. Demand and Utilization • Need – an interpretation of an individual’s evaluated requirements for obtaining professional care through the health service system • Demand – seeking out, but not necessarily receiving health services. • Utilization – actual use of services. A result of need and demand

4. Health Care Spending in the U.S. • In 2003, $1.7 trillion was spent on health care in U.S. • In 2003, the United States spent 15.3 percent of its Gross Domestic Product (GDP) on health care. Compared to other countries: • Switzerland – 10.9% • Germany – 10.7% • Canada – 9.7% • France – 9.5% • 45 million Americans were uninsured in 2003 • Total out-of-pocket spending on health care rose $13.7 billion, to $230 billion in 2003.

5. Spending by Service in Health Care 2002

6. Percent of health care expenditures 2002

7. Four Systems of Health Care • Private, insured, middle-income Americans • Poor, unemployed or under-employed Americans • Active duty military personnel • Veterans of military service

8. Private, insured, middle-income Americans • Care is coordinated by physicians in private practice • Care is funded by insurance (personal, non-governmental sources paid for by employer, individual or both) • Characterized as an informal system of care • Even though it is an informal system, patient has considerable control over their care • It is also often poorly coordinated • Medicare for the middle-income

9. Employer and Employee Health Insurance Costs • The premiums for employer-based health insurance rose by 11.2 percent in 2004, the fourth consecutive year of double-digit increases. • The annual premium that a health insurer charges an employer for a health plan covering a family of four averaged $9,950, or $829 a month in 2004. • Health insurance premium rates have risen five times faster on average than workers' earnings since 2000 • Employee spending for health insurance coverage has increased 126 percent between 2000 and 2004 • Since 2001, the employees' share of health insurance costs has soared 63 percent for single coverage and 58 percent for family coverage.

10. Poor, Unemployed/Underemployed Families Without Insurance • There is no formal system • Majority of services are provided by local government agencies • Patients have no continuity of service • In sum, the poor must take whatever they can get • Use of Medicaid and other government funded services

11. Military Medical System • A well-organized system of “high quality” care at no direct cost to the recipient • All inclusive and omnipresent • System in effect whether personnel want it or not • Emphasis is on keeping personnel well, prevention and early treatment of injury or illness • It is a closely organized, highly integrated, rational and regionalized approach

12. Veterans Administration Health Care System • Provides care to retired, disabled or other deserving veterans of military service • History of VA is rooted in controversy • Not as complete as other services • Large number of male patients • VA health system is just one of a system of social services and benefits for veterans • Interest group representation • 1990s represented a waning period for veterans and veteran services (“Snowbirds”) • Future for the veteran

13. Primary Cause of Death 1900

14. Primary Cause of Death 1997Source: Healthy People 2010