what is driving health care reform and how to use it for success edward o’neil, phd, mpa, faan...
TRANSCRIPT
What is Driving Health Care Reform and How to Use it for Success
Edward O’Neil, PhD, MPA, [email protected]
Director and ProfessorThe Center for Health Professions
University of California, San Francisco
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Health Care Cost and Obama Agenda
• Cost doubled as % of GDP in thirty years
• CBO is projecting double again to 30% by 2035.
• Increases not driven aging population
• Costs do not appear to contribute to quality.
• An enormous opportunity for the nation to rebuild health care on a more effective and responsive foundation.
Source: CBO Health Fact Sheet,
http://www.cbo.gov/publications/collections/health.
cfm
Sources of Growth in Projected Federal Spendingon Medicare and Medicaid (Percentage of GDP)
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Current Drivers - Demographic - Aging
Source: U.S. Census Bureau
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Current Drivers - Diversity- Disparity
Life Expectancy at Birth, US
6870.7
72.774.7 75.775.6
78.1 79.4 79.9 80.6
69.768.2
64.563.860
76.575.173.6
72.5
68.3
60
65
70
75
80
85
90
1970 1980 1990 2000 2006 2006
Source: National Center for Health Statistics, HHS, National Vital Statistics Report, August 19, 2009http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_01.pdf
White Male
Black Female
White Female
Black Male
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Changes in Cause of Death, 1900–1999
Source: Centers for Disease Control and Prevention. Control of infectious diseases, 1900–1999. Morbidity and Mortality Weekly Report 1999; 48:621–629.
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Growing Disease Burden
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• By 2030, 171 million Americans, nearly half the population, will have one or more chronic condition
The Number of People with Chronic Conditions is Rapidly Increasing (millions of people by year)
100110120130140150160170180
1995 2000 2005 2010 2015 2020 2025 2030
• Medicare spending is 12% of the federal budget and is expected to increase 8% every year from 2007 to 2016
Source: Wu, Shin-Yi and Green, Anthony. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, October 2000
7
30
32
34
36
38
40
Per
cent
1997 1999 2000 2001
Limitation of Activity Casused by Chronic Condition, >65
SOURCE: Health US, 2003, USHHS, CDC,NCHCS, October 2003, 56.
Current Drivers - Epidemiology
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Paradigms
• Effective tools
• Make things work
• Provide coherence
• Eventually, limit what we think we can do
• Fail0
10
20
30
40
50
60
70
80
Inputs
Pro
duct
ivit
y
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Current Situation- Comparative use
6.4 7.0 6.45.9 5.1 4.0
0.0
5.0
10.0
15.0
Japan
Germ
any
France
Canada
UK US
Annual MD Consults Percapita
SOURCE: Health Affairs, V 28, 5, 2009, p1311
21.7
1 0.90.9
0.7
0.0
1.0
2.0
Japan
Germ
any
France
Canada
UK US
Bed Days Per Capita
$2,474$3,251$3,306$3,460
$2,580
$6,347
-$1,500
$500
$2,500
$4,500
$6,500
Japan
Germ
any
France
Canada
UK US
Per Capita Spending US$
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Changing Role
• Consumer choice
• New market entrants
• Price sensitive
• 4 of 5 bankruptcies in 08
• Richer array of services
• Consolidated broker/integrators
Consumer- Emerging View
Warning: Not actual RNs
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Macro Reform: Change the Model or…
PracticeModel
ManagePrevent Diagnosis
Treat
•Training
•Money
•Technology
•Consumer
Great leverage
Long-term
Consumer driven
Expensive
Good models
Professional role
•Self-help groups
•Oral health
•Dx centers
•Self tests
•Start of life
•Drug delivery
•End of life
•Chronic diseasePracticeModels
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What does it take to keep the paradigm going?
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Transition
Today
• Acute treatment
• Cost unaware
• Professional prerogative
• In-patient
• Individual profession
• Traditional practice
• Information as record
• Patient passivity
Tomorrow
• Chronic prevention and management
• Price competitive
• Consumer responsive
• Ambulatory – Home and Community
• Team
• Evidence based practice
• Information as tool
• Consumer engagement and accountability
Strategic Success
Source: Center for the Health Professions, UCSF.
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More Help At:
HTTP://FUTUREHEALTH.UCSF.EDU
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