american health policy
TRANSCRIPT
American Health Policy: A ParadoxAmerican Health Policy: A Paradox
Pinaki BhattacharyaPinaki Bhattacharya
Four Dominant models of health financing
American Model is a peculiar mixture
Medicare(National Health Insurance Model)
• Covers the elderly (ages 65 and older) and non-elderly with disabilities
• Administered by the federal government (essentially a single-payer system … more on this in the future)
• Financed through:– Federal income taxes– Payroll taxes on employers and employees– Out-of-pocket payments by enrollees
Medicaid(Limited Beverage Model)
• Covers certain low-income individuals (pregnant, children, elderly, disabled)– Not every poor person is covered!
• Administered by state governments• Financed jointly by the state and federal
governments• Benefits are fairly comprehensive, but many
providers won’t take care of Medicaid patients– Low reimbursement rates
State Children’s Health Insurance Program (S-CHIP) (Limited Beverage Model)
• Supplements Medicaid by covering low-income children who are ineligible for Medicaid
• Administered and financed similarly to Medicaid• Similar problems to Medicaid:
– Low reimbursement rates → some providers refuse to accept S-CHIP
– Under-enrollment– Eligibility varies by specific populations and states
Other Public Insurance Programs(Beverage Model)
• Veterans Health Administration– Health benefits plan available to all veterans – Services delivered through VA health care
facilities– Financed by the federal government
• Native American Indian Health Service
U.S. Health Care FinancingU.S. Health Care Financing
Funds Payers ProvidersPublic & Private
Many "pools"Employer Multiple private payers Doctors
& many benefit plans HospitalsPremium contrib. PPO vs capitated, Pharmacies
many blends/variants Device vendorsIncome taxes Public: Medicare, Medi-Cal, Skilled Nursing Fac.
S-CHiP, VA, Indian Health,. OtherOut-of-pocket ~ 60 safety net programs
Admin costs of insurance 15%Admin costs overall 30%
Multi-payer health care financing
The Flow of the Dollar • Costs, Payment, Delivery, and Insurance Coverage are completely
intertwined in our system!
Insurance Company
Individually Insured
Government
Insured Employees
Uninsured
Physicians
EmployerPublicly Insured
Payment made to this entity
Service provided by this entity to individuals
Source: Roby DH. 2009 (forthcoming). Impacts of Being Uninsured in Handbook of Health Psychology (edited by Suls, Kaplan, Davidson), Guilford Publications: New York, NY.
Where the Health Care Dollar Came From
17%
16%
12%5%
14%
36%
Medicare
Medicaid & SCHIP
Other Public
Other Private
Private Insurance
Out-of-Pocket
Where the Health Care Dollar Went
23, 23%
30, 30%22, 22%
7, 7%
11, 11%
7, 7% Other Spending
Hospital Care
Physician & ClinicalServices
Nursing Home Care
Prescription Drugs
ProgramAdministration
US standing on health care outcomesRank of 13 industrialized nationsRank of 13 industrialized nations
Low birth weight %
Infant mortality
Years of potential life lost
Age adjusted mortality
Life expectancy @ 1 yr
Life expectancy @ 40 yrs
Life expectancy @ 65 yrs
Life expectancy @ 80 yrs
Average for all indicators
BestPoorest
(U.S. in Red)
Health Spending in the U.S. Compared to Health Spending in the U.S. Compared to Other Industrialized Countries, 2003Other Industrialized Countries, 2003
Source: Organisation for Economic Cooperation and Development Health Data (OECD), 2006
1,551
1,053
1,114
1,056
2,473
843
670
666
675
709
509
467
581
454766
- 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 5,000 5,500
U.S.
Japan
Germany
France
Canada
Per Capita Health Spending (in U.S. Dollars)
Inpatient Outpatient Ancillary
Home Health Pharmacy Nursing Home
Source: The Commonwealth Fund, calculated from OECD Health Data 2006.
Health Care Spending per Capita,1980-2004- adjusted for cost of living differences -
U.S.: $12,357 per person, 20% of GDP
by 2015
Problem lies in Philosophy of Healthcare
Contributes to 60% of health outcome
We may find an answer in
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