The Future of Nephrology is in

Disease Management

John Steel MBA ,VP FinanceCandice Halinski MSN, NP-C

Two unscheduled patients limp into two different medical clinics with the same complaint. Both have trouble walking and appear to require a hip replacement.

The FIRST goes to an emergency room….and after waiting for 4 hours, is referred back to his family Doctor who is available 3 weeks later for an appointment……he then waits 8 weeks to see a specialist, then gets an x-ray, which isn't reviewed for another week and finally has his surgery scheduled for 6 months out

The second patient is examined within 45 minutes. Within the hour, is x-rayed the same day and has a time booked for surgery the following week.

Why such different treatment and level of service for the two patients?

The FIRST is a Senior Citizen…..

The SECOND is a Golden Retriever……

“.....is destroying the "greatest health care system the world has ever known" and it is "horrible" for anyone to suggest Americans receive anything less than the best care, even though they die younger on average than people in many other countries.

"This is just one example of what happens in this country when people in Washington take on the arrogant view that they know how to fix the health care system -- one of the most massive, complex, marvelous systems the world has ever known,"

Jeff Sessions, U.S. SenatorMitch McConnell, U.S. Senator

John Boehner, Speaker – U.S. House of Representatives

We have the greatest health care system in the world. Sure, it has flaws, but it saves lives in ways that other countries can only dream of. Abroad, people sit on waiting lists for months, so why should we squander billions of dollars to mess with a system that is the envy of the world?

America's health care system is neither healthy, caring, nor a system.

Walter Cronkite

“If we keep practicing medicine as we know it today, healthcare will become an unbearable burden .......in a very near future. We are in a real race between healthcare innovation that can change this worrisome trend and the resistance to change inherent in our healthcare system.”

Elias Zerhouni, Former Director NIH

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“In God we trust; all others must bring data.”

W. Edwards Deming

We kick butt…….on spending…..

Maybe we spend more because our incomes are higher ………….then again,

maybe not………………

We spend more on everything, but especially outpatient diagnostics and procedures

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Total Health Care Spending on Health Insuranceand Administration per Capita, 2006Adjusted for Differences in the Cost of Living

$32$67

$93$74

$96

$139

$184$190$195

$243

$486

$0

$100

$200

$300

$400

$500

US (7.2%)

FRA (7.0%)

SWITZ* (4.8%)

NETH (5.6%)

GER (5.4%)

CAN (3.8%)

NZ (3.9%)

AUS* (3.1%)

OECDMedian (3.4%)

SWED (2.1%)

DEN(0.9%)

Note: Total health care spending on health insurance administration includes insurer costs only.

(Percent of total health expenditure)*2005

Data: OECD Health Data 2008 (June 2008).

We like our toys and doing the advanced stuff in the U.S.

NYT 11/30/2010Gates Seeking to Contain Military

Health CostsTen years ago, health care cost the Pentagon $19 billion; five years from now it is projected to cost $65 billion……. “Health care costs are eating the Defense Department alive,” Mr. Gates said…..

Defense budget analysts say that rising health care costs will make less money available for new weapons, repairs to a worn-out arsenal and quality-of-life programs like schools on military bases.

We are paying for the Ritz

Is that what we are getting?

American’s spend far more of national income on healthcare Yet, the U.S. is not close to full insurance coverage of its population

However, almost all of the 30 OECD countries, ………….with the exception of the US (*) ………………. have full insurance coverage of their population.

* And our close peers in Mexico and Turkey

OK, but everyone can still get care through the hospital

So…..we live longer……..right?????