Lecture Notes Module 1: Health Care and Health Care Policy. Slide 1: Introduc0on

Transcription

1 Lecture Notes Module 1: Health Care and Health Care Policy Slide 1: Introduc0on This presenta,on is intended to provide a brief introduc,on to the cri,cal issues facing the United States health care system as a result of demographic shi:s. We will be discussing: Projected growth in U.S. health care expenditures How the U.S. spends its health care dollars Where the U.S. stands in rela,on to other na,ons in terms of percentage of GDP spent on health care How aging affects these expenses Effec,ve advocacy tools Policy op,ons The impact/poten,al impact of new (or pending) legisla,on By the end of this lecture you should have a solid understanding of the cri,cal issues facing the health care field today, the proposed op,ons to rec,fy the problems, and the most effec,ve means to argue for substan,ve change.

2 Slide 2: Aging and Growth in Health Care Expenditures The economic recession and rising unemployment plus changing demographics and baby boomers aging into Medicare are among the factors expected to influence health spending during In 2009 the health share of gross domes,c product (GDP) is expected to have increased 1.1 percentage points to 17.3 percent the largest single- year increase since Average public spending growth rates for hospital, physician and clinical services, and prescrip,on drugs are expected to exceed private spending growth in the first four years of the projec,ons. As a result, public spending is projected to account for more than half of all U.S. health care spending by Truffer, Christopher et al. Health Spending Projec?ons Through 2019: The Recessions Impact Con?nues. Health Affairs (2010): As the American popula,on ages total consump,on of health care will rise with the increased incidence of chronic age related diseases. Expenditures, both public and private, will con,nue to grow at an unsustainable rate. As the chart displays, if current trends con,nue we will spend ~100% of GDP by 2082.

3 Slide 3: Who Pays The primary source of payment for health care services changes throughout a ci,zen s life. This chart displays a shi: in cost coverage from majority private to majority public sources over the course of a life,me. As the demographic composi,on of the U.S. undergoes rapid changes we cannot we con,nue to support this cost shi:ing. This chart is specifically representa,ve of the popula,on of California.

4 Slide 4: The Numbers on Medicare Examining Medicare alone does not capture the impact on health care costs created by an aging popula,on. Medicare does serve as an early indicator of the coming troubles facing government funded benefit systems. Growth in the Medicare recipient popula,on is outpacing growth in the working (payee) popula,on. As costs rise and revenues fall government is caught scrambling to restructure payment schedules for doctors in order to contain costs. In June 2010, the Senate passed a bill that temporarily spared doctors a 21% cut in Medicare payments. Both the size of the proposed cut and legislator s apprehensions about making it reality illustrate the dilemma facing the Medicare system. Medicare accounted for 20% of U.S. healthcare expenditures in 2008 The are currently nearly 45 million beneficiaries The Medicare Part A Trust Fund, which covers hospital and other health facility services that are u,lized by Medicare beneficiaries and is financed by an ear- marked payroll tax, is projected to become insolvent by 2017 under current law. The Board of Trustees, 2009 Annual Report (Wash., D.C., Federal Hospital Insurance and Federal Supplementary Insurance Trust Funds, May 12, 2009.)

5 Slide 5: The Numbers of Medicaid Medicaid, the na,on's principal safety- net health insurance program, covers health and long- term care services for 59 million low- income Americans, including children and parents, people with disabili,es, and seniors. Most children and parents covered by Medicaid are in working families. Without Medicaid, the vast majority of its enrollees would be uninsured. Na?onal 2009 Enrollment: 58,106,000 (19% of popula?on) Total Expenditures: $338,791,482,443 Growth in Medicaid Costs 04 07: 3.6% The Elderly make up ~10% of the enrollment but account for 28 % of the costs Medicaid and the Uninsured. The Kaiser Family Founda?on. November, <hep://

6 Slide 6: Where is the Money Going? Over 50% of all medical expenditures in the U.S. are spent on hospital care and clinical services. Chronic diseases (i.e. Diabetes, Heart Disease, COPD, Alzheimer s etc.) require long- term care, expensive medica,ons, and consulta,on with specialists. While nursing home care consumes only 6% of total expenditures it is important to remember that nearly every category on this chart is affected by popula,on aging. Medicare expanses rise between 27% and 31% in the last year of life for those aged 65 and older. The elderly (65+) consume 33% more health care spending per capita than any other age group. Controlling health care costs late in life is vital if we are to contain the already burgeoning U.S. na,onal deficit. Hoover, Donald R, Stephen Crystal, Rizie Kumar, Usha Sambamoorthi, and Joel C Cantor. Medical Expenditures during the Last Year of Life: Findings from the Medicare Current Beneficiary Survey. Health Serv Res. December, (6): doi: /

7 Slide 7: Cri0cal Ques0ons Now that we have taken a quick look at some sta,s,cs on Age related costs within the U.S. health care system lets consider the cri,cal issues and proposed solu,ons currently circula,ng both the public and private sector. This is a good time to pause for group discussion of the issues addressed thus far in the module.

8 Slide 8: Compara0ve Analysis The U.S. outspends every other na,on in terms of percentage of GDP spent on health care. The U.S. is the only industrialized na,on that does not provide government funded/subsidized health care to all ci,zens. The UK spends 8% or less of GDP on health care expenses against the U.S. 13%+ expenditure level. Slide 9: Health Care Costs Across the OECD The per capita cost breakdown is a good method to scale the posi,on of the U.S. alongside peer na,ons. As this slide shows the performance level circa 2007 was less than op,mal. We outspent other OECD na,ons across the board by a large margin.

9 Slide 10: Why does the U.S. Spend so Much More? The U.S. purchases a higher percentage of advanced medical procedures than other na,ons The U.S. spends more on prescrip,on drugs (o:en because of price regula,on on pharmaceu,cals in other na,ons) The U.S. spends a great deal more on health care administra,on As the popula,on ages a substan,al amount of these expenditures will be transferred from the private sector (private insurance) to the public sector (Medicare) Reinhardt, Uwe. Why does U.S. Health Care Cost So Much (Part 1)? The New York Times. 11/14/2008. <hep://economix.blogs.ny?mes.com/2008/11/14/why- does- us- health- care- cost- so- much- part- i/>

10 Slide 11: Advocacy Issues How can we advocate for both the elderly and those who are stuck paying for their care. This is a mul,faceted issue that effects the en,re na,on. Youth are saddled with insurmountable na,onal debt and care costs and the elderly are stuck facing costs they never dreamed about. What can we do? Here s a few ideas to use when deba,ng this topic: Link the concerns of the elderly to other segments of society. Convey that affordable quality care for the elderly benefits the en,re U.S. economy. Get others involved your influence is mul,plied when you can get others to join you in with your efforts; talk to people, explain the issues, share with them what they can do to make a difference. Everyone has a grandparent, everyone pays taxes (hypothe,cally), and nearly every na,on has debt. Keep the burden placed on future genera,ons in perspec,ve. The elderly are not the only people affected by the growth in na,onal health care expenditure.