wisconsin’s challenges in health care access and cost: a look at the numbers march 22, 2006 donna...
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Wisconsin’s Challenges in Health Wisconsin’s Challenges in Health Care Access and Cost:Care Access and Cost:
A Look at the Numbers A Look at the Numbers
March 22, 2006Donna Friedsam, MPH
Associate Director for Health Policy
University of Wisconsin
Population Health Institute
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The rich
THE U.S. HEALTH INSURANCE SYSTEM
The poor
The near poor
The broad middle class
The Young
Working-age people
People age 65 and over
The 40 million or so
uninsured tend to be near poor
The federal-state Medicaid
program for certain of the
poor, the blind and the disabled
The employed and their families who are typically covered through their jobs, although many small employers do not provide coverage.
For the rich, broad, unrestricted policies without rationing of any sort (Boutique medicine)
Near poor children may be temporarily covered by Medicaid and S-Chip, although 7-10 million are still uninsured.
Persons over age 65, who are covered by the federal Medicare program, but not for drugs or long-term care. Often the elderly have private supplemental MediGap insurance
The very poor elderly are also covered by Medicaid
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Health Insurance Coverage - WisconsinHealth Insurance Coverage - Wisconsin
Employer-Sponsored: 65% (Adults <65: 75%) Other private: 4% Medicaid only: 7%(Any Medicaid: 9%) Any Medicare: 14% Other Types: 4% No Insurance at a given point-in-time: 6%***************************************** Adults > 65: 94% Medicare; 7% Medicaid Medicaid: 9% of Wisconsin households Medicaid coverage 19% of Wisconsin children
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Medicare SpendingMedicare Spending
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State Role in Health Care State Role in Health Care
PurchasersMedicaid, HIRSP, other safety net programs
EmployerDept. of Employee Trust Funds $800 million annual health care expenditures
PolicymakersRegulate insurance marketRules of pricing and competition
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High Cost Burden on High Cost Burden on EmployersEmployers
Employers now spend on average about 15% of payroll – For insuring employers, close to 16%– Cost rising 10-25% per year– Adverse economic effects on Wisconsin – on
wages, profits, job creation, new investment
– Source: Wisconsin Health Project
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Wisconsin’s Current Wisconsin’s Current Health Care Fiscal PressuresHealth Care Fiscal Pressures
Ongoing Medicaid deficits Double-digit insurance cost increases Employers dropping or limiting coverage Increasing numbers of uninsured Increasing under-insured Dramatic enrollment increases for MA,
BadgerCare, HIRSP
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Safety Net ProgramsSafety Net Programs
19% of Wisconsin children have Medicaid coverage
9% of Wisconsin household residents have Medicaid coverage, including BadgerCare, Healthy Start, and other forms of Medical Assistance
Enrollment in the Wisconsin’s Health Insurance Risk Sharing Pool (HIRSP) has grown from 7,257 in FY 2000 to 18,820 in February 2000.
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Who is Uninsured in Wisconsin?Who is Uninsured in Wisconsin?
545,000 residents (11%) of population for all or part of 2004
At any given point in time, 7% of Wisconsin’s residents (377,000) are uninsured.
91,000 Wisconsin children uninsured for all or part of 2004
Source: Wisconsin Family Health Survey, 2004, Wisconsin Department of Health & Family Services
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Most Uninsured Adults are Most Uninsured Adults are EmployedEmployed
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Medicaid Eligibility
0%
50%
185%
100%
200%
150%
September 2001
FederalPoverty Level
Eligibility Groups
250%
53%
93%
250%
BadgerCare &Family Medicaid
Caretaker Relatives in
Family Medicaid
Adults onSSI or
SSI-relatedMedicaid
MedicaidPurchase Plan
(MAPP)200%
(No Asset Test) (No Asset Test) ($2,000 Asset Limit) ($15,000 Asset Limit)
Parents &Children < 19
Caretakers who are not
parents
Elderly, Blind& Disabled
Adults
WorkingDisabledAdults
Adults who are not:•Elderly• Disabled•Caretaker Relatives
210%
Long TermCare
Medicaid
($2,000 Asset Limit)
Persons in aa long term care
institution or participating
in a communitywaivers program
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Medicaid & Badgercare Enrollment TrendMedicaid & Badgercare Enrollment Trend
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Trends in MA/BC ExpendituresTrends in MA/BC Expenditures
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Medicaid ExpendituresMedicaid Expenditures
Elderly and disabled account for 28% of Medicaid enrollment, and account for more than 70% of the Medicaid expenditures.
Low income families and others represent 72% of enrollees and account for 28% of expenditures.
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Medicaid Average Medicaid Average Annual Cost per PersonAnnual Cost per Person
Elderly: $21,724
Disabled: $11,956
Low-income family members: $ 2,107
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Where are the Costs?Where are the Costs?
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25% of Population Accounts for 25% of Population Accounts for 80% of Spending80% of Spending
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Health Care Resource ConsumptionHealth Care Resource Consumption
Catastrophic
Chronic
Episodic
Well
24
33
25
18
1
5
14
81
Percent Of Resources Used
Percent Of Population
Chart: RWHC, 9/03Data: Cerner Corporation, '99 and Wisconsin Hospital Association, 9/03
National Health Reform Needs To Follow The Money
Type Of Care
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15 Health Conditions Drive Cost Inflation15 Health Conditions Drive Cost Inflation
Increased treatment prevalence or population growth
Increase in cost of treating these conditions Top five conditions account for 31% of increase in
spending between 1987-2000. Obesity accounts for 27% of growth in spending,
with associated increased spending in heart disease (41%), diabetes (38%), hyperlipidemia (22%).
Source: Thorpe, KE and colleagues, Health Affairs, 2004
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Increasing Cost per Treated CaseIncreasing Cost per Treated Case
In 8 of top 15 conditions, increase cost per Tx, rather than rising numbers of cases, accounted for most increase spending.
More expensive and effective drugs and technologies accounted for nearly 70% of increase spending for CHD 1987-2000.
Rise in hypertension Tx cost accounted for 60% of the overall growth in spending.
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Emergency Dept. UtilizationEmergency Dept. Utilization
Urgent visits increased by 8%.
ER is the highest cost point of entry to care.
In Wisconsin, the number of non-urgent ER visits in 2000 increased by 17% from
1997.
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Concerns of WI ResidentsConcerns of WI Residents
Health care now tied with taxes as subject of greatest concern: 17%
Unemployment & jobs: 16%
Source: WI Policy Research Institute
October 2004
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What issues should be given the most What issues should be given the most attention by state government?attention by state government?
35%: “Controlling health care and prescription drug costs”
17%: improving the state’s economy” 15% “improving public education” 12%: “reforming the tax system” 11%: “placing limits on WI government agencies” 7%: “security from terrorist attacks” 3%: other or not sure
Source: WI Policy Research Institute, October 2004
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Contact InformationContact Information
Donna FriedsamAssociate Director for Health Policy
UW Population Health InstituteV 608.263.4881
Email [email protected]://www.pophealth.wisc.edu/wphi