U.S. Healthcare

Cost, Access, Quality

Cost

Per Capita

• National Health Expenditure was $8,086 per person in 2009 which equals a total of $2.5 trillion.

Allocation of Funds

• The total spending for Medicare totaled $502.3 billion in 2009.

• The total spending for Medicaid totaled $373.9 billion in 2009.

• The total spending for private insurance totaled $802.1 billion in 2009.

• The total spending for out of pocket payments totaled $299.3 billion in 2009.

(Source: U.S. Department of Health & Human Services)

Payment

1.Insurance companies 2.The government 3.Paying out of pocket

Payment - Insurance Companies

• The cost of health insurance will depend on your age, how healthy you are, where you live, your income and your job status.

• There is a fee that must be paid monthly to the insurance company called a premium • For those who are employed typically have their health insurance paid for by their employer.

• If you are self-employed you must pay for your own insurance and the price of the premium will depend on what health insurance plan you choose.

• “On average the annual premium was $2,985 for a single person and $6,328 for a family” (Bihari, 2). That’s $250 a month for a single person and $530 for a family per month just to have insurance, not to actually receive healthcare.

Payment - The Government

• Helps to pay for insurance for the elderly and those below the poverty line through Medicare and Medicaid.

• Medicare provides health insurance to people who are at least 65 years old.

• Medicaid is a health program for those with low incomes and resources. It is jointly funded by the state and federal governments.

• "The poverty rate in 2010 was 15.1 percent—up from 14.3 percent in 2009. This was the third consecutive annual increase in the poverty rate. Since 2007, the poverty rate has increased by 2.6 percentage points, from 12.5 percent to 15.1 percent" (DeNavas-Walt, Proctor & Smith, 14).

Payment - Out of Pocket

• Two options: to buy health insurance or to hope they do not need to use the healthcare system.

• Many choose not to pay for insurance and cannot afford health care at regular clinics.

• “The average expense for a physician's office visit was $155. For primary care physicians —general practice, family medicine, internal medicine and pediatric physicians —the average was about $100,for a cardiologist $232, for an orthopedist, $210, or the $206 average cost of seeing an ophthalmologist” (Blythe, 1).

• As a result, the emergency room of the hospital is abused because it cannot turn people away due to lack of insurance or ability to pay.

Institutions

Public VS. Private

Institutions - Public

• The government is the main public institution that helps to cover the cost of health care.

• Hospitals take advantage of the government being a "faceless consumer" and will charge more than they charge insurance companies for the same treatment.

• In 2007, federal spending on health programs cost $808.6 billion with 77% being attributed to Medicare and Medicaid (Jenson, 2).

Institutions - Private

• Private institutions refer to private insurance or private payers of health care.

• Insurance companies use diagnosis-related groups (DRGs) in order to determine the reimbursement rate for a specific diagnosis. Hospitals must then negotiate with insurance companies to set rates.

• Private insurance accounts for 35% of total health spending within the United States.

References

• Bihari, M. (2010, April 02). Cost of health insurance. Retrieved from http://healthinsurance.about.com/od/healthinsurancebasics/a/cost_of_health_insuranc e.htm

• Blythe, S. (2009). What is an "office visit," anyway?. Retrieved from http://uninsuredinamerica.org/visits/services.htm • DeNavas-Walt, C., Proctor, B. D., & Smith, J. C. U.S. Department of Commerse, Economics and Statistics Administration. (2010).Income, poverty, and health insurance coverage in the united states: 2010. Retrieved from http://www.census.gov/prod/2011pubs/p60-239.pdf

• Jenson, J. Domestic Social Policy Devision, (2008). Government spending on health care benefits and programs: a data brief. Retrieved from http://aging.senate.gov/crs/medicaid7.pdf •

Primary Care Doctors Account for Nearly Half of Physician Visits but Less Than One-Third

of Expenses. AHRQ News and Numbers, April 25, 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/nn/nn042507.htm

Access to Care

1.Right to Access 2.Knowledge of the System/Transparency 3.Socioeconomic Status 4.Dispersion

5.Medical Decisions

Access-Right to Access

• Market-driven health care industry: profit is the #1 priority o Accessibility suffers as a result • Key factor to health care access is good health insurance o Mostly obtained through employment • 3 main categories of individuals to consider: 1.Poor

2."Working Poor" (little access to care) 3.Wealthy

(Bodenheimer & Grumbach, 2011)

Access- Knowledge of System and Transparency

• US health system is very complex and hard to understand • Without a high level of education and literacy, you cannot effectively understand the health care system • A lack of knowledge of the system can create barriers to health care access and can cause inequalities as well • Lack of understanding by minorities causes health care access issues (Betancourt & Green, 2011)

Access- Socioeconomic Status

• More than 49.9 million uninsured Americans (US Census Bureau, 2011) • More than 60 percent of the uninsured are in low-income families (Adler & Newman, 2002) • Large majority of the uninsured are from racial/ethnic minority groups (US Census Bureau, 2011) o Cannot afford private health insurance o Do not qualify for public health insurance program (e.g. Medicaid, Medicare)

Access- Dispersion

Since the United States healthcare system is a capitalistic system, healthcare providers may practice wherever they would like.

* However, many providers choose to live in cities or nice areas, which creates a problem for poor and rural geographic locations.

Access- Dispersion

The dispersion of healthcare frequently limits accessibility to Americans.

* People in rural communities have poorer health status and greater needs for primary health care, yet they are not as well served and have more difficulty accessing healthcare services than people in urban centers.

* Additional health care concerns have included quality of care, specialization of services, ambulatory care, and emergency treatment, all factors that have definitetly impacted the health of rural persons.

Access- Medical Decisions

Medical decisions in the United States are often rationed based on price and ability to pay.

* If one cannot afford private health insurance, they are frequently unable to access healthcare unless covered by a government program.

* Medical decisions are not always based on whether one patient needs a particular treatment more than another; it is determined by who will pay for it.

* Example: If one can afford a private health insurance plan that will cover heart surgery, that person will have access to heart surgery.

Access- Medical Decisions

Regardless of whether or not they are medically qualified, health insurance companies also make medical decisions.

* Although health insurance companies are not making diagnosis, they determine whether or not a treatment will be covered.

* Health insurance companies are not trained in the medical field, yet they have a lot of control over patients' treatment plans.

References

Adler, N.E., & Newman K. (2002). Socioeconomic Disparities In Health: Pathways And Policies. Health Aff. 21(2), 60-76.

Betancourt J.R., Green A.R. (2011). Chapter e4. Racial and Ethnic Disparities in Health Care. In: D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e. Retrieved October 23, 2011 from http://www.accessmedicine.com

Bodenheimer TS, Grumbach K. (2011). Chapter 3. Access to Health Care. In: T.S. Bodenheimer, K. Grumbach (Eds), Understanding Health Policy: A Clinical Approach, 5e. http://www.accessmedicine.com.

US Census Bureau. (2011).

60-233.

Income, Poverty, and Health Insurance Coverage in the United States

,

2011.

Quality

1. Health Indicators 2. Focus of Care 3. Technology/ Treatment

Health Indicators

* Global Rating: 37  Health level  Responsiveness  Financial fairness  Health distribution  Responsiveness distribution * Life Expectancy: 78 years and 2 months * Infant Mortality: 6.42 deaths per 1,000 live births * Gross Domestic Product (GDP) spent on healthcare: 16%

Focus of Care

* Primary Care * Secondary Care * Tertiary Care

Focus of Care

Primary Care

* Usually the first point of contact for a patient * Typically provided by general practitioners/family doctors, dentists, pharmacists, midwives, etc * Most preventative health and early diagnosis can be achieved * Involves communicating with patients, going out into the community, using outreach programs for promoting good health and preventative strategies, and more * Extremely cost-effective

Focus of Care

Secondary Care

* Usually when a primary care person such as a doctor refers a patient to a specialist * Typically do not have continuous contact with patients like primary care providers, but address more complex conditions

Tertiary Care

* Specialized consultive care, often hospital care * Often abused and most expensive

Focus of Care

The United States health care system is mainly focused on secondary and tertiary care.

* Allocation of Funds * Insurance coverage

Focus of Care

Generalists

* In the United States, much lower in number * Family physician

Specialists

* In the United States, higher is number * Requires additional schooling, more "prestigious," paid more * Pediatrician, Cardiologist, Surgeon

Technology/ Treatment

* The United States emphasizes research in comparison to primary care.

* The USA is the world leader when it comes to medical innovation as well as converting new ideas into workable commercial technologies.

References

Cowen, Tyler. "Poor U.S. Scores in Health Care Don't Measure Nobels and Innovation."

New York Times

. N.p., 5 Oct. 2006. Web. 22 Oct. 2011. .

The

Jones, Andrew M., Nigel Rice, Silvana Robone, and Pedro R. Dias. "Inequality and Polarisation in Health Systems’ Responsiveness: A Cross- Country Analysis ."

Health, Econometrics, and Data Group

. The University of York, Oct. 2010. Web. 22 Oct. 2011. .

Shah, Anup. "Health Care Around the World."

Global Issues

. N.p., 22 Sept. 2011. Web. 22 Oct. 2011. .

"WHO Issues New Healthy Life Expectancy Rankings."

Press Releases 2000

. WHO, June 2000. Web. 22 Oct. 2011. .

Summary

Cost * More money per person is spent on healthcare in the USA than in any other country in the world. Access * To see a doctor in the United States (not in the ER), one must have health insurance.

Quality * Due to the emphasis on new technology advancements and lack of emphasis on primary care, the USA has a global rating of 37.