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THE
COMMONWEALTH FUND
1
Source: KFF/HRET Survey of Employer-Sponsored Health Benefits: 2005.*Estimate is statistically different from the previous year shown at p<0.05.^ Estimate is statistically different from the previous year shown at p<0.1.Note: Data on premium increases reflect the cost of health insurance premiums for a family of four. Historical estimates of workers’ earnings have been updated to reflect new industry classifications (NAICS).
12.0
18.0
0.8
13.9^
12.9*10.9*
8.2*
5.3*
11.2*
8.5 9.2*
0
5
10
15
20 Health Insuranc e P remiumsWorkers EarningsOverall Inflation
Figure 1. Increases in Health Insurance Figure 1. Increases in Health Insurance Premiums Compared to Other Indicators, 1988–Premiums Compared to Other Indicators, 1988–
20052005Percent
THE
COMMONWEALTH FUND
2Figure 2. Deductibles Rise Sharply, Especially in Figure 2. Deductibles Rise Sharply, Especially in
Small Firms, Over 2000–2005*Small Firms, Over 2000–2005*
*Out-of-network deductibles are for 2000 and 2004.Source: J. Gabel and J. Pickreign, Risky Business: When Mom and Pop Buy Health Insurance for Their Employees (Commonwealth Fund, April 2004); KFF/HRET Employer Health Benefits 2005 Annual Survey.
210
383
157
319
469
676
254
510
$0
$150
$300
$450
$600
$750
$9002000 2005
In-network Out-networkOut-network In-networkSmall Firms,
3-199 EmployeesLarge Firms,
200+ Employees
PPO in-network and out-of-network deductibles
THE
COMMONWEALTH FUND
3
606366666869
0
25
50
75
2000 2001 2002 2003 2004 2005
Figure 3. Percent of Firms Offering Health Benefits Figure 3. Percent of Firms Offering Health Benefits Declined Over 2000–2005Declined Over 2000–2005
Source: KFF/HRET Employer Health Benefits 2005 Annual Survey.
Percent of firms offering health benefits
THE
COMMONWEALTH FUND
4Figure 4. 46 Million Uninsured in 2004; Figure 4. 46 Million Uninsured in 2004;
Increasing Steadily Since 2000Increasing Steadily Since 2000
Number of uninsured, in millions
31 33 33 35 3539 40 40 41 42 43 44
40 40 4144
56
45
0
20
40
60
1987 1990 1993 1996 1999* 2002 2005 2008 2011
Projected
2013
*1999–2003 estimates reflect the results of follow-up verification questions and implementation of Census 2000-based population controls.Note: Projected estimates for 2004–2013 are for nonelderly uninsured based on T. Gilmer and R. Kronick, “It’s the Premiums, Stupid: Projections of the Uninsured Through 2013,” Health Affairs Web Exclusive, April 5, 2005.Source: U.S. Census Bureau, March CPS Surveys 1988 to 2005.
5
THE COMMONWEALTH
FUND
0
1000
2000
3000
4000
5000
6000
0 100 200 300 400 500 600 700 800 900
a
*Allan Hubbard, Director of the National Economic Council, February 14, 2006.Note: Adjusted for Differences in the Cost of Living, 2003.Source: Bianca K. Frogner and Gerard F. Anderson, “Multinational Comparisons of Health Systems Data, 2005,” The Commonwealth Fund, Forthcoming.
a2002 Out-of-Pocket Health Care Spending per Capita, US$
National Health Expenditures per Capita, US$
United States
Australia
OECD Median
Canada
Japana
New Zealand
GermanyFranceNetherlands
Figure 5. Greater Out-of-Pocket Costs are Not Figure 5. Greater Out-of-Pocket Costs are Not Associated with Lower Health Spending in Associated with Lower Health Spending in
Cross-National ComparisonsCross-National Comparisons
6
THE COMMONWEALTH
FUND
Figure 6. Americans Are Spending More Figure 6. Americans Are Spending More Out-of-Pocket for Health CareOut-of-Pocket for Health Care
0
100
200
300
400
500
600
700
800
900
Source: C. Smith et al., “National Health Spending in 2004: Recent Slowdown Led by Prescription Drug Spending,” Health Affairs 25, no. 1 (January/February 2006); Centers for Medicare and Medicaid Services, National Health Expenditures Data; http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf
Dollars spent per capita (in 2004 dollars)
$577 $583
$774
$667
$788
7
THE COMMONWEALTH
FUND
8
1112
15
0
10
20
1996–97 2001–02
Percent of families with high out-of-pocket medical costsrelative to income, not including premiums
Figure 7. Nearly One of Six Families Spent 10% or Figure 7. Nearly One of Six Families Spent 10% or More of Income (or 5% or More if Low-Income) on More of Income (or 5% or More if Low-Income) on
Out-of-Pocket Medical Costs, 2001–02Out-of-Pocket Medical Costs, 2001–02
*Low-income includes families with incomes <200% of the federal poverty level.Source: M. Merlis, D. Gould and B. Mahato, Rising Out-of-Pocket Spending for Medical Care: A Growing Strain on Family Budgets (New York: The Commonwealth Fund) February 2006.
Spent >10% of income Spent >10% of income, or >5% of income if low-income*
8
THE COMMONWEALTH
FUND
Figure 8. Cost-Sharing Reduces Use of Both Figure 8. Cost-Sharing Reduces Use of Both Essential and Less Essential Drugs and Increases Essential and Less Essential Drugs and Increases
Risk of Adverse EventsRisk of Adverse Events
9
1514
22
0
5
10
15
20
25
Essential Less Essential
E lderly Low Inc ome
Source: R. Tamblyn et al., “Adverse Events Associated With Prescription Drug Cost-Sharing Among Poor and Elderly Person,” JAMA 285, no. 4 (2001): 421–429.
Percent reduction in drugs per day
117
43
9778
0
20
40
60
80
100
120
140
Adverse Events ED V is its
E lderly Low Inc ome
Percent increase in incidence per 10,000
9
THE COMMONWEALTH
FUND
Figure 9. Few Insured People Are Currently Covered by Figure 9. Few Insured People Are Currently Covered by High Deductible Health Plans (HDHP) or Consumer High Deductible Health Plans (HDHP) or Consumer
Directed Health Plans (CDHP) with a Directed Health Plans (CDHP) with a Savings AccountSavings Account
HDHP
9%
CDHP
1%
Comprehens ive
89%
Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam); HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account; CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey, EBRI Issue Brief, December 2005.
10
THE COMMONWEALTH
FUND
Figure 10. FEHBP HDHP/HSAs Plans Enroll 7,500 out Figure 10. FEHBP HDHP/HSAs Plans Enroll 7,500 out of 9 Million Covered Livesof 9 Million Covered Lives
6.4
0.10
5
10
15
20
25
Perc ent of FEHBP plans that
are HDHP /HSAs
Perc ent of FEHBP enrollees
that are in HDHP /HSAs
Note: As of March 2005.Source: Government Accountability Office, Federal Employees Health Benefits Program First-Year Experience with High-Deductible Health Plans and Health Savings Accounts, Washington, DC: GAO, January 2006; OPM, http://www.opm.gov/insure/handbook/FEHBhandbook.pdf
Percent
11
THE COMMONWEALTH
FUND
Figure 11. Enrollees Who Chose HDHPs From the Federal Figure 11. Enrollees Who Chose HDHPs From the Federal Employees Health Benefits Program Are More Likely to Employees Health Benefits Program Are More Likely to
Earn Higher IncomesEarn Higher Incomes
43
23
0
25
50
75
HDHP A ll FEHBP plans
Source: Government Accountability Office, Federal Employees Health Benefits Program First-Year Experience with High-Deductible Health Plans and Health Savings Accounts, Washington, DC: GAO, January 2006.
Percent of FEHBP enrollees with incomes ≥ $75,000
12
THE COMMONWEALTH
FUND
Figure 12. Age Distribution of HDHP and Other Figure 12. Age Distribution of HDHP and Other FEHBP EnrolleesFEHBP Enrollees
0
5
10
15
20
25
30
35
<23 23-34 35-44 45-54 55-64 65-74 75-99 >99
HDHP enrollees A ll FEHBP enrollees
Source: Government Accountability Office, Federal Employees Health Benefits Program First-Year Experience with High-Deductible Health Plans and Health Savings Accounts, Washington, DC: GAO, January 2006.
Percent FEHBP enrollees
13
THE COMMONWEALTH
FUND
Figure 13. Less than Half of Those Enrolled in Figure 13. Less than Half of Those Enrolled in Employer-Based High Deductible Health Plans Had Employer-Based High Deductible Health Plans Had
a Choicea Choice
58
47 45
0
25
50
75
Traditional(n=1016)
CDHP HDHP
Percent of adults with employer-based coverage who were offered a choice of health plans
• CDHP and HDHP owners are less likely to have a choice of plans from their employer
• When they have a choice, the savings account is the leading reason for choosing CDHP, while premium cost is the most frequent reason for choosing HDHP. Traditional plans are chosen for low out-of-pocket costs.(n=134) (n=334)
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey, EBRI Issue Brief, December 2005.
14
THE COMMONWEALTH
FUND
Figure 14. Enrollees of HDHP/CDHPs Are Less Figure 14. Enrollees of HDHP/CDHPs Are Less Satisfied with Their CoverageSatisfied with Their Coverage
8
28
63
29
3933 32
26
42
0
25
50
75
Extremely or very
satisfied
Somew hat
satisfied
Not satisfied
Comprehens ive HDHP CDHPPercent
*
**
**
*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05 or better.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey, EBRI Issue Brief, December 2005.
15
THE COMMONWEALTH
FUND
Figure 15. Enrollees of HDHP/CDHPs Are Less Figure 15. Enrollees of HDHP/CDHPs Are Less Satisfied with Out-of-Pocket CostsSatisfied with Out-of-Pocket Costs
21
3642
31
12
57
1828
54
0
25
50
75
Extremely or very
satisfied
Somew hat
satisfied
Not satisfied
Comprehens ive HDHP CDHP
*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05 or better.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey, EBRI Issue Brief, December 2005.
Percent
* *
**
*
16
THE COMMONWEALTH
FUND
Figure 16. Enrollees of HDHP/CDHPs Are Less Likely Figure 16. Enrollees of HDHP/CDHPs Are Less Likely To Stay With Their Current Health Plan If They Had To Stay With Their Current Health Plan If They Had
the Opportunity to Changethe Opportunity to Change
11
28
61
33*37*
30*21
33*
46*
0
25
50
75
Extremely or very
likely to s tay
Somew hat likely
to s tay
Not likely to s tay
Comprehens ive HDHP CDHP
*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05 or better.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey, EBRI Issue Brief, December 2005.
Percent of adults 21–64
17
THE COMMONWEALTH
FUND
Figure 17. Enrollees of HDHP/CDHPs Are Less Likely Figure 17. Enrollees of HDHP/CDHPs Are Less Likely to Recommend their Plan To a Friend or Co-Workerto Recommend their Plan To a Friend or Co-Worker
2426
5143*
34*
22*31 35*34*
0
25
50
75
Extremely or very
likely
Somew hat likely Not likely
Comprehens ive HDHP CDHP
*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05 or better.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey, EBRI Issue Brief, December 2005.
Percent of adults 21–64
18
THE COMMONWEALTH
FUND
Figure 18. Workers are Less Satisfied When Their Costs Figure 18. Workers are Less Satisfied When Their Costs Go Up – Employer Costs Go Down but at the Risk of Go Up – Employer Costs Go Down but at the Risk of
Alienating WorkersAlienating Workers
431 610
2270
3413
1348323
553
0
1000
2000
3000
4000Deduc tible c ontributionP remium c ontribution
^ “All plans” refers to all conventional HMOs, PPOs, and POS plans in the survey, not just HDHP/HRA or HSA-qualified HDHPs. Source: Calculated based on: G. Claxton et al., “What High Deductible Health Plans Look Like: Findings from a National Survey of Employers, 2005,” Health Affairs Web Exclusive, September, 14, 2005; J. Gabel et al., “Health Benefits in 2005: Premium Increases Slow Down, Coverage Continues to Erode,” Health Affairs, September/October 2004.
All plans^
All plans^
$1,779
$933
$2,823
Dollars
$3,413
Worker contribution Employer contribution
HSA-qualified
HDHP
HSA-qualified
HDHP
19
THE COMMONWEALTH
FUND
Figure 19. Enrollees of HDHP/CDHPs Spend Higher Figure 19. Enrollees of HDHP/CDHPs Spend Higher Percent of Income on Out-of-Pocket Medical Percent of Income on Out-of-Pocket Medical
Expenses and PremiumsExpenses and Premiums
9 132529
35
58
23 26
44
0
20
40
60
80
100 10%+ of inc ome 5-9% of inc ome
Percent of adults 21–64 spending > 5% of income
Total Health Problem<$50,000
Annual Income
12
4231
17
3834
92
66
53
13* 9* 18* 12* 1033* 21
3 4
(n = 61)
(n = 90)
*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05 or better.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey, EBRI Issue Brief, December 2005.
**
*
*
*
**
**
*
*
20
THE COMMONWEALTH
FUND
Figure 20. Enrollees of HDHP/CDHPs Are More Figure 20. Enrollees of HDHP/CDHPs Are More Likely to Delay or Avoid Getting Health Care Likely to Delay or Avoid Getting Health Care
When Sick Due to CostWhen Sick Due to Cost
2621
17
42
313135
48
40
0
25
50
75
Total Health P roblem <$50,000 Annual
Inc ome
Comprehens ive HDHP CDHP
Percent of adults 21–64
(n = 61)
(n = 90)
*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05 or better.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey, EBRI Issue Brief, December 2005.
*
*
*
**
*
21
THE COMMONWEALTH
FUND
Figure 21. Enrollees of HDHP/CDHPs Are More Figure 21. Enrollees of HDHP/CDHPs Are More Likely To Skip Doses to Make Medications Last Likely To Skip Doses to Make Medications Last
32
20 212015
35
26 2829
0
20
40
60
Total Health Problem** <$50,000 Annual
Income
Comprehensive HDHP CDHP
**Health problem defined as fair or poor health or one of eight chronic health conditions.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey, EBRI Issue Brief, December 2005.
Percent of adults 21–64 with prescriptions in last twelve months
(n = 50)(n = 85)**
22
THE COMMONWEALTH
FUND
Figure 22. Enrollees of HDHP/CDHPs Are More Figure 22. Enrollees of HDHP/CDHPs Are More Likely to Not Fill a Prescription Due to CostLikely to Not Fill a Prescription Due to Cost
2027
2116
323326
2526
0
25
50
75
Total Health P roblem <$50,000 Annual
Inc ome
Comprehens ive HDHP CDHP
Percent of adults 21–64
(n = 61)(n = 90)
**
*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05 or better.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey, EBRI Issue Brief, December 2005.
23
THE COMMONWEALTH
FUND
Figure 23. People with Higher Deductibles More Likely Figure 23. People with Higher Deductibles More Likely to Have Medical Debt or Problems Paying Medical Bills to Have Medical Debt or Problems Paying Medical Bills
in Past Year, by Size of Deductiblein Past Year, by Size of Deductible
5446
39
24
0
20
40
60
$1,000 or more $500–$999 $1–$499 N one
Percent of adults ages 19–64 with any medical bill problem or outstanding debt*
Size of deductible
^^
^
Note: Adjusted percentages based on logistic regression models; controlling for health status and income.
*Problems paying/not able to pay medical bills, contacted by a collection agency for medical bills,had to change way of life to pay bills, or has medical debt being paid off over time.
^Significant difference at p < .05 or better; referent category = no deductible.
Source: The Commonwealth Fund Biennial Health Insurance Survey (2003).
24
THE COMMONWEALTH
FUND
Figure 24. Increased Health Care Costs Have Figure 24. Increased Health Care Costs Have Reduced SavingsReduced Savings
Has increased spending on health care expenses in the past year caused you to do any of the following? Among those with health insurance coverage who had increases in health care costs in the last year (n=731) (percentage saying yes)
45%
34%
29%
26%
24%
18%
Decrease your contributions to a retirement plan, such as a 401(k),
403(b) or 457 plan, or an IRA
Have difficulty paying for other bills
Decrease your contributions to other savings
Use up all or most of your savings
Borrow money
Have difficulty paying for basic necessities, like food, heat, and housing
Source: EBRI Health Confidence Survey, 2005.
25
THE COMMONWEALTH
FUND
Figure 25. Most Insured Do Not Have Quality and Cost Figure 25. Most Insured Do Not Have Quality and Cost Information to Make Informed ChoicesInformation to Make Informed Choices
Comprehensive HDHP/CDHPHealth plan provides information on quality of care provided by:
Doctors 14% 16%
Hospitals 14 15
Health plan provides information on cost of care provided by:
Doctors 16 12
Hospitals 15 12
Of those whose plans provide info on quality, how many tried to use it for:
Doctors 42 54
Hospitals 25 45
Of those whose plans provide info on cost, how many tried to use it for:
Doctors 15 36 (n = 76)
Hospitals 14 32 (n = 76)
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey, EBRI Issue Brief, December 2005.
26
THE COMMONWEALTH
FUND
Figure 26. Cost Conscious Decision-Making, by Figure 26. Cost Conscious Decision-Making, by Insurance SourceInsurance Source
27
43
49
19
32*
44*
55*
60*
14
23
0 25 50 75
Checked quality rating ofdoctor or hospital
Checked price of serv ice
Asked doctor torecommend less costly
prescription drugs
Talked to doctor abouttreatment options & costs
Checked whether planwould cover care
Comprehens ive
HDHP /CDHP
*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05 or better.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey, EBRI Issue Brief, December 2005.
Percent of adults 21–64 who received health care in last twelve months
27
THE COMMONWEALTH
FUND
Figure 27. HSAs Won’t Solve the Cost Problem:Figure 27. HSAs Won’t Solve the Cost Problem:Most Costs Are Concentrated in the Very SickMost Costs Are Concentrated in the Very Sick
0%
10%
20%30%
40%
50%
60%
70%80%
90%
100%
U.S. Population Health Expenditures
1%5%
10%
55%
69%
27%
Source: A.C. Monheit, “Persistence in Health Expenditures in the Short Run: Prevalence and Consequences,” Medical Care 41, supplement 7 (2003): III53–III64.
Distribution of Health Expenditures for the U.S. Population, By Magnitude of Expenditure, 1997
50%
97%
$27,914
$7,995
$4,115
$351
Expenditure Threshold (1997
Dollars)
28
THE COMMONWEALTH
FUND
Figure 28. Most Trusted Sources for Information on Figure 28. Most Trusted Sources for Information on Health Care Providers, by Insurance SourceHealth Care Providers, by Insurance Source
10
15
20
4342
25
16
8
4
2
6
2
0 20 40 60
Government or other
agenc y
Ow n health plan
Medic al assoc iation
F amily member or friend
Consumer group
Y our doc tor
Comprehens ive
HDHP /CDHP
*Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05 or better.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey, EBRI Issue Brief, December 2005.
Percent of adults 21–64
29
THE COMMONWEALTH
FUND
Figure 29. Uninsured Rates High Among Adults Figure 29. Uninsured Rates High Among Adults with Low and Moderate Incomes, 2001–2005with Low and Moderate Incomes, 2001–2005
15 17 18
33 37 37
1724 28
9
9 9 9
1615 16
1111
13
9
76 2 33
7 9
0
25
50
75 Insured now , time uninsured in pas t year
U ninsured now
Percent of adults ages 19–64
Note: Income refers to annual income. In 2001 and 2003, low income is <$20,000, moderate income is $20,000–$34,999, middle income is $35,000–$59,999, and high income is $60,000 or more. In 2005, low income is <$20,000, moderate income is $20,000–$39,999, middle income is $40,000–$59,999, and high income is $60,000 or more. Source: S.R. Collins et al., Gaps in Health Insurance Coverage: An All-American Problem, Findings from The Commonwealth Fund Biennial Health Insurance Survey, The Commonwealth Fund, April 2006.
26
52
35
16
4
24
49
28
13
4
Total Low income Moderate income
Middle income
High income2001 2003 2005 2001 2003 20052001 2003 20052001 2003 20052001 2003 2005
28
53
41
18
7
30
THE COMMONWEALTH
FUND
Figure 30. Distribution of Uninsured Figure 30. Distribution of Uninsured Young Adults 19–29 by Poverty Status, 2004Young Adults 19–29 by Poverty Status, 2004
Source: S.R. Collins, C. Schoen, J.L. Kriss, M.M. Doty, B. Mahato, Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help, The Commonwealth Fund, updated May 2006.
Less than 100% FPL
40%
100%–199% FPL
29%
200% FPL or more
31%
31
THE COMMONWEALTH
FUND
Figure 31. HSAs Won’t Solve the Uninsured Figure 31. HSAs Won’t Solve the Uninsured Problem: Income Tax Distribution of UninsuredProblem: Income Tax Distribution of Uninsured
55% (0% tax bracket)
16% (10% tax bracket)
23% (15% tax bracket)
5% (27% tax bracket)
1% (30%-39%
tax bracket)
Source: S.A. Glied, The Effect of Health Savings Accounts on Health Insurance Coverage, The Commonwealth Fund, April 2005.
32
THE COMMONWEALTH
FUND
Figure 32. Medicare Physician Group Practice Figure 32. Medicare Physician Group Practice DemonstrationDemonstration
• The Everett Clinic (WA)• Deaconess Billings Clinic• Park Nicollet Health
Services (MN)• Marshfield Clinic (WI)• St. John’s Health System
(MO)
Source: “Medicare Physician Group Practice Demonstration,” www.cms.gov, January 31, 2005.
• Univ. of Michigan Faculty Group Practice
• Geisinger Health System (PA)
• Forsyth Medical (NC)• Middlesex Health (CN)• Dartmouth-Hitchcock
Clinic
• 10 physician group practices
• 3-year project, began April 2005
• Bonus pool based on savings relative to local area
• Practices expected to save 2%, keep up to 80% of additional savings
• Actual bonuses depend on savings and quality targets
33
THE COMMONWEALTH
FUND
Figure 33. Building Quality Into RIte CareFigure 33. Building Quality Into RIte CareHigher Quality and Improved Cost TrendsHigher Quality and Improved Cost Trends
• Quality targets and $ incentives
• Improved access, medical home
– One third reduction in hospital and ER
– Tripled primary care doctors
– Doubled clinic visits
• Significant improvements in prenatal care, birth spacing, lead paint, infant mortality, preventive care
Source: Silow-Carroll, Building Quality into RIte Care, Commonwealth Fund, 2003. Tricia Leddy, Outcome Update, Presentation at Princeton Conference, May 20, 2005.
Cumulative Health Insurance Rate Trend Comparison
0
20
40
60
80
100
120
140
160
RI Commercial Trend
RIte Care Trend
Percent
THE
COMMONWEALTH FUND
34Figure 34. Lacking Health Insurance for Any Period Figure 34. Lacking Health Insurance for Any Period
Undermines Quality and EfficiencyUndermines Quality and Efficiency
59
35
58
2718 16
0
25
50
75
Skipped doses or did not fi ll
presc ription for c hronic c ondition
bec ause of c os t
V is ited ER, hospital, or both for
c hronic c ondition
U ninsured now Insured now , time uninsured in past year Insured all year
Percent of adults ages 19–64 with at least one chronic condition*
* Hypertension, high blood pressure, or stroke; heart attack or heart disease; diabetes; asthma, emphysema, or lung disease. Source: S.R. Collins et al., Gaps in Health Insurance Coverage: An All-American Problem, Findings from The Commonwealth Fund Biennial Health Insurance Survey, The Commonwealth Fund, April 2006.
THE
COMMONWEALTH FUND
35
1510
193026
41
1923
0
25
50
75
T es t results or
rec ords not
available at time of
appointment
Duplic ate tes ts
ordered
Never rec eived
lab/diagnos tic tes t
results or delay in
rec eiving abnormal
results
Any lab tes t/
rec ord problem
Insured all year Uninsured during the year
Figure 35. Adults Without Insurance Have Figure 35. Adults Without Insurance Have More Problems With Lab Tests and RecordsMore Problems With Lab Tests and Records
Source: S.R. Collins et al., Gaps in Health Insurance Coverage: An All-American Problem, Findings from The Commonwealth Fund Biennial Health Insurance Survey, The Commonwealth Fund, April 2006.
Percent of adults ages 19–64 reporting the following problems in past two years:
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