Jesse D. Ibarra Jr. M.D.Jesse D. Ibarra Jr. M.D.

Lectureship

in International Health

Lectureship

in International Health

Jesse D. Ibarra Jr. M.D.Jesse D. Ibarra Jr. M.D.• Native of Leon, Mexico

• National University of Mexico

• Internship & Residency - S&W

• Senior Staff S&W - 1950 Endocrinology

• Clinic Board of Directors 1973-1984

• VP Clinic Board for 5 years

• Special Projects Committee

• Native of Leon, Mexico

• National University of Mexico

• Internship & Residency - S&W

• Senior Staff S&W - 1950 Endocrinology

• Clinic Board of Directors 1973-1984

• VP Clinic Board for 5 years

• Special Projects Committee

Jesse D. Ibarra Jr. M.D.Jesse D. Ibarra Jr. M.D.

• President S&W Health Plan 1984-1989

• Member State Board of Medical Examiners 1977 - 1988

• Retired from S&W 1988

• Latin American Task Force until 1999

• President S&W Health Plan 1984-1989

• Member State Board of Medical Examiners 1977 - 1988

• Retired from S&W 1988

• Latin American Task Force until 1999

TECHNOLOGY TECHNOLOGY and the and the

FUTURE of HEALTHCAREFUTURE of HEALTHCARE

Ronald R. Blanck, D.O.Ronald R. Blanck, D.O.

LTG, USA (Retired)LTG, USA (Retired)

PresidentPresident

University of North Texas Health Science CenterUniversity of North Texas Health Science Center

Medicine TodayMedicine Today

Unprecedented Growth in

● Technology

● Choices in Treatment Modalities

● Evidence – Based Medicine

● Diagnostic Tools

Healthcare TodayHealthcare Today

Technology

● Procedures

● Pharmaceuticals

● Blood Products

● Imaging

● Information

Centers for Medicare & Medicaid ServicesJune 2002 Edition

0

2

4

6

8

10

12

14

16

18

1980 1985 1990 1995 2000 2005 2010

Note: Nominal: values expressed in current dollar terms (not adjusted for inflation). Real: values deflated by the GDP chain-weightedprice index.

Source: CMS, Office of the Actuary, National Health Statistics Group.

Calendar Years

Pe

rce

nt

Real

Nominal

Nominal health expenditure growth is projected to exceed the growth of the mid- to late1990s, but fall short of the growth experienced in the late 1980s.

Actual Projected

Growth in National Health Expenditures

Section I. Page 24

Centers for Medicare & Medicaid ServicesJune 2002 Edition

8

10

12

14

16

18

20

1980 1985 1990 1995 2000 2005 2010

Source: CMS, Office of the Actuary, National Health Statistics Group .

Calendar Years

Pe

rce

nt

of

GD

P

Actual Projected

Between 2001 and 2011, health spending is projected to grow 2.5 percent per year fasterthan GDP, so that by 2011 it will constitute 17 percent of GDP.

National Health Expenditures as a Share ofGross Domestic Product (GDP)

Section I. Page 25

Centers for Medicare & Medicaid ServicesJune 2002 Edition

0

2

4

6

8

10

12

14

16

18

20

1984 1989 1994 1999

Source: CMS, Office of the Actuary, National Health Statistics Group .

Calendar Years

Pe

rce

nt

Share of NHE

Growth

Sharply rising prescription drug expenditure growth nationwide in the mid- to late 1990scaused noticeable growth in prescription drugs as a share of total health spending.

17.3

9.4

12.1

4.9

Prescription Drug Expenditure Growth and Share ofNational Health Expenditures

Section I. Page 1

. . . And Unprecedented Growth In:. . . And Unprecedented Growth In:

● Medical Costs (e.g. Meds, Procedures , Liability)

● Regulations (e.g. HIPPA, Multiple Payor Forms)

● Prescriptions per Patient

● Aging Population

● Under or Uninsured

● Emerging Diseases (e.g. Asthma, AIDS, TB)

Healthcare ExpendituresHealthcare Expenditures

● Up 7.8% in 2002 to 1.674 Trillion

(CMS)

● 14.9% of GDP in 2002

● At 1% over economic growth - 38% of GDP in 2075

Healthcare TodayHealthcare Today

● Best Disease Care

● Complex

● Expensive

● Error - Prone

● Regulated

● Inaccessible to Many

GOLDEN AGE OF MEDICINEGOLDEN AGE OF MEDICINE. . . for Some. . . for Some

Person with Public and Private Person with Public and Private Coverage, and the Uninsured, Coverage, and the Uninsured,

1990-19991990-1999

0

50

100

150

200

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

UninsuredUninsured Public coverage Private Public coverage Private coveragecoverage

Source: HIAA, 1990-2000Source: HIAA, 1990-2000

Millions of Millions of personspersons

The number of uninsured lives is on the rise again.The number of uninsured lives is on the rise again.

Number and Percent Uninsured1985 - 2002

0

5

10

15

20

25

30

35

40

45

50

85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 020%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Source: US Census Bureau.

Num

ber

of U

nins

ured

in

Mill

ions

Per

cent

of

Tot

al P

opul

atio

n

The UninsuredThe Uninsured

MEDICAL CARE IS . . . MEDICAL CARE IS . . . DISEASE CARE RATHER DISEASE CARE RATHER

THEN HEALTH CARETHEN HEALTH CARE

Healthcare TodayHealthcare TodayOur Health System is a NON-SystemOur Health System is a NON-System

Emphasizing Disease By:

● Education

● Research

● Payment

Today’s preventive care allows Today’s preventive care allows longer life, but more illness-longer life, but more illness-requiring more costly carerequiring more costly care

Health Care CostHealth Care Cost

Focus on cost of reduction is Focus on cost of reduction is piecemeal and may be short-sighted:piecemeal and may be short-sighted:

e.g. reduced payments may be e.g. reduced payments may be counter-productive, potentially counter-productive, potentially reduces early care and accessreduces early care and access

Healthcare Cost (cont.)Healthcare Cost (cont.)

Instead of only looking at cost reduction, look at distribution . . . and efficiencies . . . and what medical/health care is about:

● To heal

● To maintain health/quality of life

Healthcare Costs (cont.)Healthcare Costs (cont.)

Question Is -

How Best To Do:

● Medical (disease) care

● Preventive and early detection care

● Both Efficiently

Goal is toGoal is to

Rationalize and systematize Rationalize and systematize medical and healthcare for medical and healthcare for efficiency and quality of lifeefficiency and quality of life

There is no system of medical There is no system of medical care in the U.S.care in the U.S.

There is a System of There is a System of Healthcare - Healthcare - PUBLIC HEALTHPUBLIC HEALTH

● Water Purification

● Food Safety

● Sanitation

● Immunizations

Biological WarfareBiological Warfare

The intentional use of The intentional use of microorganisms or toxins derived microorganisms or toxins derived from living organisms to produce from living organisms to produce

death or disease in humansdeath or disease in humans, , animals or plantsanimals or plants

BW AgreementsBW Agreements

● 1925 Geneva Protocol

● 1969 Nixon renounces BW

● 1972 Biological Weapons Convention

● 1975 Geneva Conventions Ratified

Biological Weapons PolicyBiological Weapons Policy

● No use under any circumstance

● Research limited to defensive measures

● We possess NO weaponized biologicals

● Previous weapons stocks destroyed

● Destruction supervised: - USDA

- Dept of HEW

- DNR of AR, CO, MD

The Sverdlovsk IncidentThe Sverdlovsk Incident

● April - May 1979- 66 Anthrax fatalities

● 1988- Soviets present data: ○ 96 cases ○ 79 gastrointestinal

● May 1992- Yeltsin admits

“military developments”

Advantages of BW:Advantages of BW:Are Biologicals the Ultimate Weapons?Are Biologicals the Ultimate Weapons?

● Agent easy to procure● Inexpensive to produce● Can disseminate at great distance● Agent clouds invisible● Detection quite difficult● First sign is illness● Overwhelms medical capabilities● Simple threat creates panic● Perpetrators escape before effects● Ideal terrorist weapon

Acquisition of Etiologic AgentsAcquisition of Etiologic Agents

● Multiple Culture Collections

● Universities

● Commercial Supply Houses

● Foreign Laboratories

● Field Samples or Clinical Specimens

Hazardous Biological MaterialHazardous Biological Material

● Letters

● Packages

● Cultures

● Person-to-person

● Airborne

ResponseResponse

● Not Typical First Responders

● BIO First Responders- Physician’s Office- ER- Clinics- Public Health

● All Organizations Involved

IssuesIssues

● Rapid Detection

● Public Health

● Hospital Capacity

● Stockpiling

● Vaccine Production

. . . . . . BIOTERRORISM HAS BIOTERRORISM HAS CHANGED THE FOCUS OF CHANGED THE FOCUS OF

OUR APPROACH TO PUBLIC OUR APPROACH TO PUBLIC HEALTHHEALTH

Public Health In the ForefrontPublic Health In the Forefront

● Population Health

● Education

● Early Detection

● Immunizations

Steps to a System of CareSteps to a System of Care● Tort Reform

● Single Payor

● Linked Information Systems

● Lifetime Electronic Patient Records

● Change in Priorities for

- Education

- Research

- Payment

Future . . .Future . . .

● Public Health; Prevention/Health Promotion

● New Paradigm of Care Based on Linking:

Technology Prevention

Efficiency

● Best use of $ Systematically

The endThe end

Please continue to the post testDownload the post testComplete the post testSend the post test to:

– Dr. Sandra Oliver– 407 I TAMUII

Post Test Question 1Post Test Question 1

1. Which of the following statement regarding health care expenditures is

incorrect

A. Up 7.8% in 2002 to 1.674 Trillion (CMS)

B. 14.9% of GDP in 2002

C. Approximately 55 percent of Medicaid is financed by state funds

D. At 1% over economic growth - 38% of GDP in 2075

Post test Question 2Post test Question 2

2. Over the decade of the 90’s the number of persons with private health care coverage has:

A. Increased

B. Decreased

C. Remained upchanged

Post test question 3Post test question 3

3. Powers and duties of public health officers include all of the following except:

A. Tertiary health care programs

B. Water Purification

C. Food Safety

D. Sanitation

E. Immunizations

Post test Question 4Post test Question 4

4. According to R.R. Blanck, the first responders to biological warfare will be:

A. Infectious disease physicians

B. Firemen/EMT

C. Primary care providers

D. Toxicologists