common challenges
DESCRIPTION
Common Challenges. US and Canadian Health Care CSG – ERC August 9, 2011. US Health System Accident of History. Early USVeteran’s support 1930’sVeteran’s Administration 1940’sEmployer Sponsored Insurance 1965Medicare – over 65 Medicaid – low income - PowerPoint PPT PresentationTRANSCRIPT
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Common Challenges
US and Canadian Health Care
CSG – ERC August 9, 2011
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US Health SystemAccident of History
• Early US Veteran’s support • 1930’s Veteran’s Administration• 1940’s Employer Sponsored
Insurance• 1965 Medicare – over 65
Medicaid – low income• 1997 Children’s Health Insurance
(CHIP)• 2010 Affordable Care Act
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Our Hodgepodge System
• Costs more than other OECD countries
• Doesn’t cover everybody
• Far from seamless• Dismantling 80 years
of a piecemeal policy approach tremendous challenge
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International Comparison of Spending on Health, 1980–2008
0
1000
2000
3000
4000
5000
6000
7000
8000
19
80
19
81
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82
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83
19
84
19
85
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86
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87
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88
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89
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90
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91
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92
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93
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94
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United StatesNorwaySwitzerlandCanadaNetherlandsGermanyFranceDenmarkAustraliaSwedenUnited KingdomNew Zealand
Average spending on healthper capita ($US PPP)
0
2
4
6
8
10
12
14
16
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
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1995
1996
1997
1998
1999
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2007
2008
United StatesFranceSwitzerlandGermanyCanadaNetherlandsNew ZealandDenmarkSwedenUnited KingdomNorwayAustralia
Total expenditures on healthas percent of GDP
Source: OECD Health Data 2010 (June 2010).
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Life Expectancy at Birth, 2007
81.1 80.782.282.382.382.482.983.083.083.784.084.284.4
78.2 77.1 75.477.278.077.278.278.978.479.078.479.277.5
0
10
20
30
40
50
60
70
80
90
FR SWITZ* ITA* AUS CAN* SWE NOR* GER* NETH OECDMedian
NZ UK** US*
Female Male
* 2006** 2005Source: OECD Health Data 2009 (June 2009).
Years
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QUALITY
COSTACCESS
Balancing Needs and Viewpoints
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Let’s Look at Ourselves
• Canada• 34 million • 68% 15 – 64• 16% over 65• 81 – life expectancy
@birth• 81% population urban
• Source CIA World Factbook
• United States• 313 million• 67% 15 – 64• 13% over 65• 78 – life expectancy
@ birth• 82% population urban
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Out-of-Pocket Spending of $1,000 or More
in the Past Year, by Income
Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status.
* Indicates significant within-country differences with below-average income (p < 0.05).
31
17
510 11 11
16
2
34
0
45
1612
5 5 7 6
15
2
20
0
29
0
15
30
45
60
AUS* CAN* FR GER* NETH NZ* NOR SWE SWIZ* UK US*
Above-average income Below-average income
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
(Adjusted) percent
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Challenges
• Changing demographics
• Cost
• Workforce
• Improving delivery of care
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Changing demographics
• Ethnicity
• Age
• Languages spoken
• Generations
• Attracting workforce to deliver care to changing demographics
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Cost
CHALLENGES
Aging Boomers will drive volume regardless of financing approach
“80/20 rule” – lifestyle choices and chronic conditions
Fragmented care
Inefficient care – duplication etc.
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Workforce
• AAMC projects 91,500 shortage of physicians by 2020; nearly half primary care
• Health professionals are aging too!
• Supply and distribution problems
• BLS March 2011 healthcare sector added 37,000 new jobs – largest increase in any employment sector
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Looking Ahead - US
• Patient Centered Medical Home– Payment Reform– Scope of Practice
• Accountable Care Organizations– Team approach – best care, less spending– Evidence based medicine
• Technology – health information exchanges and electronic medical records
• Incentives – Loan Repayment
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CONTACT INFORMATION
Paula K. Roy
Executive Director
Delaware Health Care Commission
Margaret O’Neil Building
410 Federal St. Suite 7
Dover, DE 19901
302-739-2730
302-739-6927 fax
www.dhcc.delaware.gov