U.S. Healthcare

1
U.S. Healthcare

• Cost, Access, Quality

2
Cost
3
Per Capita

• National Health Expenditure was 8,086 per person
  in 2009 which equals a total of 2.5 trillion.

4
Allocation of Funds

• The total spending for Medicare totaled 502.3
  billion in 2009.
• The total spending for Medicaid totaled 373.9
  billion in 2009.
• The total spending for private insurance totaled
  802.1 billion in 2009.
• The total spending for out of pocket payments
  totaled 299.3 billion in 2009.
• (Source U.S. Department of Health Human
  Services)

5
Payment

• Insurance companies
• The government
• Paying out of pocket
•  

6
Payment - Insurance Companies

• The cost of health insurance will depend on your
  age, how healthy you are, where you live, your
  income and your job status.
• There is a fee that must be paid monthly to the
  insurance company called a premium
•  For those who are employed typically have their
  health insurance paid for by their employer. 
• If you are self-employed you must pay for your
  own insurance and the price of the premium will
  depend on what health insurance plan you choose.
• On average the annual premium was 2,985 for a
  single person and 6,328 for a family (Bihari,
  2). Thats 250 a month for a single person and
  530 for a family per month just to have
  insurance, not to actually receive healthcare. 

7
Payment - The Government

• Helps to pay for insurance for the elderly and
  those below the poverty line through Medicare and
  Medicaid.
• Medicare provides health insurance to people who
  are at least 65 years old.
• Medicaid is a health program for those with low
  incomes and resources. It is jointly funded by
  the state and federal governments. 
• "The poverty rate in 2010 was 15.1 percentup
  from 14.3 percent in 2009. This was the
  third consecutive annual increase in the poverty
  rate. Since 2007, the poverty rate has increased
  by 2.6 percentage points, from 12.5 percent to
  15.1 percent" (DeNavas-Walt, Proctor Smith,
  14). 

8
Payment - Out of Pocket

• Two options to buy health insurance or to hope
  they do not need to use the healthcare system. 
• Many choose not to pay for insurance and cannot
  afford health care at regular clinics.
• The average expense for a physician's office
  visit was 155. For primary care
  physiciansgeneral practice, family medicine,
  internal medicine and pediatric physiciansthe
  average was about 100,for a cardiologist 232,
  for an orthopedist, 210, or the 206 average
  cost of seeing an ophthalmologist (Blythe, 1). 
• As a result, the emergency room of the hospital
  is abused because it cannot turn people away due
  to lack of insurance or ability to pay. 

9
Institutions

• Public VS. Private

10
Institutions - Public

• The government is the main public institution
  that helps to cover the cost of health care.
• Hospitals take advantage of the government being
  a "faceless consumer" and will charge more than
  they charge insurance companies for the same
  treatment. 
•  In 2007, federal spending on health programs
  cost 808.6 billion with 77 being attributed to
  Medicare and Medicaid (Jenson, 2).

11
Institutions - Private

• Private institutions refer to private insurance
  or private payers of health care.
• Insurance companies use diagnosis-related groups
  (DRGs) in order to determine the reimbursement
  rate for a specific diagnosis. Hospitals must
  then negotiate with insurance companies to set
  rates. 
•  Private insurance accounts for 35 of total
  health spending within the United States.

12
References

• Bihari, M. (2010, April 02). Cost of health
  insurance. Retrieved from http//healthinsurance.a
  bout.com/od/healthinsurancebasics/a/cost_of_health
  _insurance.htm
• Blythe, S. (2009). What is an "office visit,"
  anyway?. Retrieved from http//uninsuredinamerica.
  org/visits/services.htm
• DeNavas-Walt, C., Proctor, B. D., Smith, J. C.
  U.S. Department of Commerse, Economics and
  Statistics Administration. (2010).Income,
  poverty, and health insurance coverage in the
  united states 2010. Retrieved from
  http//www.census.gov/prod/2011pubs/p60-239.pdf
• Jenson, J. Domestic Social Policy Devision,
  (2008). Government spending on health care
  benefits and programs a data brief. Retrieved
  from http//aging.senate.gov/crs/medicaid7.pdf
• Primary Care Doctors Account for Nearly Half of
  Physician Visits but Less Than One-Third of
  Expenses. AHRQ News and Numbers, April 25, 2007.
  Agency for Healthcare Research and Quality,
  Rockville, MD. http//www.ahrq.gov/news/nn/nn04250
  7.htm

13
Access to Care

1. Right to Access
2. Knowledge of the System/Transparency
3. Socioeconomic Status
4. Dispersion
5. Medical Decisions 

14
Access-Right to Access

• Market-driven health care industry profit is the
  1 priority 
• Accessibility suffers as a result
• Key factor to health care access is good health
  insurance
• Mostly obtained through employment
•  3 main categories of individuals to consider
• Poor
• "Working Poor" (little access to care)
• Wealthy
•                                               
                          (Bodenheimer Grumbach,
  2011)

15
Access- Knowledge of System and Transparency

• US health system is very complex and hard to
  understand
• Without a high level of education and literacy,
  you cannot effectively understand the health care
  system 
• A lack of knowledge of the system can create
  barriers to health care access and can cause
  inequalities as well
• Lack of understanding by minorities causes health
  care access issues (Betancourt Green, 2011)

16
Access- Socioeconomic Status

• More than 49.9 million uninsured Americans (US
  Census Bureau, 2011)
• More than 60 percent of the uninsured are in
  low-income families (Adler  Newman, 2002)
• Large majority of the uninsured are from
  racial/ethnic minority groups (US Census Bureau,
  2011)
• Cannot afford private health insurance
• Do not qualify for public health insurance
  program (e.g. Medicaid, Medicare)

17
Access- Dispersion

• Since the United States healthcare system is a
  capitalistic system, healthcare providers may
  practice wherever they would like.
•      However, many providers choose to live in
  cities or nice     
•       areas, which creates a problem for poor and
  rural
•       geographic locations. 

18
Access- Dispersion

• The dispersion of healthcare frequently limits
  accessibility to Americans.
•     
•      People in rural communities have poorer
  health status and
•       greater needs for primary health care, yet
  they are not as 
•       well served and have more difficulty
  accessing healthcare
•       services than people in urban centers. 
•      Additional health care concerns have
  included quality of 
•       care, specialization of services,
  ambulatory care, and 
•       emergency treatment, all factors that have
  definitetly 
•       impacted the health of rural persons.

19
Access- Medical Decisions

• Medical decisions in the United States are often
  rationed based on price and ability to pay. 
•      If one cannot afford private health
  insurance, they are 
•       frequently unable to access healthcare
  unless covered by
•       a government program.
•      Medical decisions are not always based on
  whether 
•       one patient needs a particular treatment
  more than 
•       another it is determined by who will pay
  for it. 
•      Example If one can afford a private health
  insurance plan
•       that will cover heart surgery, that person
  will have access 
•       to heart surgery.
•    
•    

20
Access- Medical Decisions

• Regardless of whether or not they are medically
  qualified, health insurance companies also make
  medical decisions.
•      Although health insurance companies are not
  making 
•       diagnosis, they determine whether or not a
  treatment will 
•       be covered. 
•      Health insurance companies are not trained
  in the medical
•       field, yet they have a lot of control over
  patients' treatment 
•       plans. 
•     
•     

21
References

• Adler, N.E., Newman K. (2002). Socioeconomic
  Disparities In Health Pathways And Policies.
  Health Aff. 21(2), 60-76.
• Betancourt J.R., Green A.R. (2011). Chapter e4.
  Racial and Ethnic Disparities in Health Care. In
  D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser,
  J.L. Jameson, J. Loscalzo (Eds), Harrison's
  Principles of Internal Medicine, 18e. Retrieved
  October 23, 2011 from http//www.accessmedicine.co
  m
• Bodenheimer TS, Grumbach K. (2011). Chapter 3.
  Access to Health Care. In T.S. Bodenheimer, K.
  Grumbach (Eds), Understanding Health Policy A
  Clinical Approach, 5e. http//www.accessmedicine.c
  om.
• US Census Bureau. (2011). Income, Poverty, and
  Health Insurance Coverage in the United States,
  2011. 60-233. 

22
Quality

• 1. Health Indicators
• 2. Focus of Care
• 3. Technology/ Treatment

23
Health Indicators

• Global Rating 37
• Health level
• Responsiveness
• Financial fairness
• Health distribution
• Responsiveness distribution
• Life Expectancy 78 years and 2 months 
• Infant Mortality 6.42 deaths per 1,000 live
  births 
• Gross Domestic Product (GDP) spent on
  healthcare 16

24
Focus of Care

• Primary Care
• Secondary Care
• Tertiary Care

25
Focus of Care

• Primary Care
• Usually the first point of contact for a
  patient
• Typically provided by general
  practitioners/family doctors, dentists,
  pharmacists, midwives, etc
• Most preventative health  and early diagnosis
  can be achieved 
• Involves communicating with patients, going out
  into the community, using outreach programs for
  promoting good health and preventative
  strategies, and more
• Extremely cost-effective

26
Focus of Care

• Secondary Care
•      Usually when a primary care person such as
  a doctor refers
•        a patient to a specialist
•      Typically do not have continuous contact
  with patients 
•         like primary care providers, but address
  more complex 
•         conditions
• Tertiary Care
•     
•      Specialized consultive care, often hospital
  care
•      Often abused and most expensive

27
Focus of Care

• The United States health care system is mainly
  focused on secondary and tertiary care. 
•      Allocation of Funds
•      Insurance coverage

28
Focus of Care

• Generalists
•      In the United States, much lower in number
•      Family physician
• Specialists
•      In the United States, higher is number
•      Requires additional schooling, more
  "prestigious," paid 
•       more
•      Pediatrician, Cardiologist, Surgeon

29
Technology/ Treatment

• The United States emphasizes research in
  comparison to  
•    primary care. 
• The USA is the world leader when it comes to
  medical 
•    innovation as well as converting new ideas
  into workable 
•    commercial technologies. 

30
References

• Cowen, Tyler. "Poor U.S. Scores in Health Care
  Don't Measure Nobels and Innovation." The New
  York Times. N.p., 5 Oct. 2006. Web. 22 Oct. 2011.
  lthttp//www.nytimes.com/2006/10/05/business/05scen
  e.htmlgt.
• Jones, Andrew M., Nigel Rice, Silvana Robone, and
  Pedro R. Dias. "Inequality and Polarisation in
  Health Systems Responsiveness A Cross- Country
  Analysis ." Health, Econometrics, and Data Group.
  The University of York, Oct. 2010. Web. 22 Oct.
  2011. lthttp//www.york.ac.uk/res/herc/documents/wp
  /10_27.pdfgt.
• Shah, Anup. "Health Care Around the
  World." Global Issues. N.p., 22 Sept. 2011. Web.
  22 Oct. 2011. lthttp//www.globalissues.org/article
  /774/health-care-around-the-worldgt.
• "WHO Issues New Healthy Life Expectancy
  Rankings." Press Releases 2000. WHO, June 2000.
  Web. 22 Oct. 2011. lthttp//www.who.int/inf-pr-2000
  /en/pr2000-life.htmlgt.

31
Summary

•  

32
 

• Cost
•     More money per person is spent on
  healthcare in the USA
•      than in any other country in the world.  
• Access
•     To see a doctor in the United States (not
  in the ER), one
•      must have health insurance. 
• Quality
•     Due to the emphasis on new technology
  advancements 
•       and lack of emphasis on primary care, the
  USA has a 
•       global rating of 37.