Transcript Disease, Healthcare, and Poverty

Disease, Healthcare, and
Poverty
Addison Chung
Alexia Capsuto
Glenn Burgan
Serena Anand
How do disease, healthcare, and
poverty connect?
• Those who are in poverty don't have access to healthcare,
which means that when they get sick they can't afford
medical services to recover.
• Often, people's healthcare comes from their employer, so
if the primary provider for a family is unemployed (and
therefore the family is in poverty), the family doesn't have
medical insurance.
• "Health Inequality" is the term used to describe unfair
disparities between two demographics
Common Medical Procedure Costs
•Ambulance
ride
$500-$1,000
•Fixing a broken arm
$2,523
•A regular office visit
$80
•Step on a rusty nail
$1,030
•Allergic reaction to a bee sting
$1,050
•Appendectomy
$12,000-$14,000 (depending on hospital stay)
How many people have healthcare in
America?
• Nearly 45.5 million Americans-- 7 million of whom are
children-- are uninsured (about 15% of the total
population)
• 16 million (about 5% of the population) more have such
inadequate coverage that they are forced to forgo
needed care.
How much does healthcare cost?
It costs an average of $8,160 per person to be
insured, and is expected to reach $13,100 by the year
2013.
The United States currently expends 14 percent of its
gross domestic product (GDP) on health care, but that is
expected to rise in the next decade.
Indemnity vs. HMO vs. Medicare
• Indemnity Insurance
o
o
o
o
•
Before 1990, most health insurance was this type
Simply reimburses patients for medical expenses
Patient is free to see any doctor
The patient pays the doctor and receives back most of the cost from the insurance
company.
Health Maintenance Organizations (HMO)
Also called managed care
Since 1990, it has dominated the market and now covers 85% of employed
Americans
o Insurance companies hire doctors and hospitals to provide care for their
subscribers, who pay a monthly premium and small copayments to use those
services.
o Costs somewhat less
o Subscribers agree to go to only the doctors and hospitals the company employs
and the insurer decides what medical care they will pay for.
o
o
• Medicare/Medicaid
o
o
National healthcare plans
Medical insurance programs for the elderly, the disabled, and the poor created by
President Lyndon B. Johnson in 1965 through an amendment to the 1935 Social
Security Act
More on Medicare and Medicaid
Medicare (Title XVIII of the
Social Security Act)
• Provides health insurance for
people aged 65 and over and
those seriously disabled
• Covers short-term hospital and
nursing home expenses, physician
and outpatient services, and
home health care.
• Does not cover long-term nursing
home care, dental and eye care,
or prescription drugs.
Beneficiaries pay a portion of the
insured services.
Medicaid (Title XIX of the Social
Security Act)
• Provides insurance for certain
needy individuals.
• Federal government provides
partial funding but states run the
program within broad guidelines.
• The states must cover hospital,
physician, diagnostic, and home
health services; nursing home care;
and family planning for
beneficiaries.
• Coverage of prescription drugs,
eyeglasses, and intermediate care
is optional.
• Provides money for the treatment
of patients with AIDS.
• Called Medi-Cal in California
Who gets government healthcare?
• People with disabilities and the elderly have the highest priority.
• Parents, or adults with many dependents, have priority for
government healthcare when in poverty.
In 1997, Massachusetts raised the income threshold for Medicaid eligibility for
parents from 86% to 133% of poverty, and began providing premium assistance
support to parents with incomes up to 200% of poverty.
o In 1999, Wisconsin expanded coverage to parents with incomes up to 185% of
poverty, an increase from 51%.
o In 2000, New Jersey expanded coverage to parents with incomes up to 200% of
poverty, up from 41%.
o Also in 2000, California raised the income threshold for parents from 74% to
100% of poverty.
o
• Those without dependents have lower priority.
o
Massachusetts, which had previously not provided any coverage for nondisabled
childless adults, began in 1997 providing premium assistance to such adults with
incomes up to 200% of poverty.
How do we stack up?
1 France 2 Italy 3 San Marino 4 Andorra 5 Malta 6 Singapore 7 Spain 8 Oman 9 Austria 10 Japan 11
Norway 12 Portugal 13 Monaco 14 Greece 15 Iceland 16 Luxembourg 17 Netherlands 18 United
Kingdom 19 Ireland 20 Switzerland 21 Belgium 22 Colombia 23 Sweden 24 Cyprus 25 Germany 26
Saudi Arabia 27 United Arab Emirates 28 Israel 29 Morocco 30 Canada 31 Finland 32 Australia 33
Chile 34 Denmark 35 Dominica 36 Costa Rica 37 United States of America 38 Slovenia 39 Cuba 40 Brunei 41 New
Zealand 42 Bahrain 43 Croatia 44 Qatar 45 Kuwait 46 Barbados 47 Thailand 48 Czech Republic 49 Malaysia 50
Poland 51 Dominican Republic 52 Tunisia 53 Jamaica 54 Venezuela 55 Albania 56 Seychelles 57 Paraguay 58
South Korea 59 Senegal 60 Philippines 61 Mexico 62 Slovakia 63 Egypt 64 Kazakhstan 65 Uruguay 66 Hungary 67
Trinidad and Tobago 68 Saint Lucia 69 Belize 70 Turkey 71 Nicaragua 72 Belarus 73 Lithuania 74 Saint Vincent
and the Grenadines 75 Argentina 76 Sri Lanka 77 Estonia 78 Guatemala 79 Ukraine 80 Solomon Islands 81
Algeria 82 Palau 83 Jordan 84 Mauritius 85 Grenada 86 Antigua and Barbuda 87 Libya 88 Bangladesh 89
Macedonia 90 Bosnia-Herzegovina 91 Lebanon 92 Indonesia 93 Iran 94 Bahamas 95 Panama 96 Fiji 97 Benin 98
Nauru 99 Romania 100 Saint Kitts and Nevis 101 Moldova 102 Bulgaria 103 Iraq 104 Armenia 105 Latvia 106
Yugoslavia 107 Cook Islands 108 Syria 109 Azerbaijan 110 Suriname 111 Ecuador 112 India 113 Cape Verde 114
Georgia 115 El Salvador 116 Tonga 117 Uzbekistan 118 Comoros 119 Samoa 120 Yemen 121 Niue 122 Pakistan
123 Micronesia 124 Bhutan 125 Brazil 126 Bolivia 127 Vanuatu 128 Guyana 129 Peru 130 Russia 131 Honduras
132 Burkina Faso 133 Sao Tome and Principe 134 Sudan 135 Ghana 136 Tuvalu 137 Ivory Coast 138 Haiti 139
Gabon 140 Kenya 141 Marshall Islands 142 Kiribati 143 Burundi 144 China 145 Mongolia 146 Gambia 147 Maldives
148 Papua New Guinea 149 Uganda 150 Nepal 151 Kyrgystan 152 Togo 153 Turkmenistan 154 Tajikistan 155
Zimbabwe 156 Tanzania 157 Djibouti 158 Eritrea 159 Madagascar 160 Vietnam 161 Guinea 162 Mauritania 163
Mali 164 Cameroon 165 Laos 166 Congo 167 North Korea 168 Namibia 169 Botswana 170 Niger 171 Equatorial
Guinea 172 Rwanda 173 Afghanistan 174 Cambodia 175 South Africa 176 Guinea-Bissau 177 Swaziland 178 Chad
179 Somalia 180 Ethiopia 181 Angola 182 Zambia 183 Lesotho 184 Mozambique 185 Malawi 186 Liberia 187
Nigeria 188 Democratic Republic of the Congo 189 Central African Republic 190 Myanmar
Mandated Healthcare
• Massachusetts has a progressive mandated healthcare plan
that most would agree is a critical test for health care
reform.
– Massachusetts does not fine for failure to purchase insurance.
– Massachusetts created a reformed insurance market called a
connector to make affordable insurance available to all.
• More than half of the uninsured have been covered, but
this was accomplished mostly with added public financing
that subsidized the purchase of private insurance and
expanded Medicaid.
• The state has projected that program costs may run
hundreds of millions of dollars over budget.
• Massachusetts has quickly expanded coverage to the
working poor, but it remains to be seen whether
affordability, cost control, quality improvement, and
universal coverage can be accomplished
What will President Obama do?
• Obama pushes for eventual
universal healthcare. In his
plan, people choose:
– Government plan that can be
subsidized if you can’t afford
it
– Individual private healthcare
• Healthcare issues are being
considered as part of the
early stimulus package to
prevent people who lose
their jobs from losing their
coverage.
Who has access to healthcare?
• 86% of women in the United States report having some
sort of healthcare, compared to only 74% of men who
have healthcare.
• In a study by the Centers for Medicare and Medicaid
Services (CMS), the greatest deficiency in care was
observed for African Americans, who had a 60% greater
likelihood of receiving inadequate dialysis (treatment for
kidney disease) compared with whites.
• Young adults are the nation’s largest group of uninsured
— there were 13.2 million of them nationally in 2007, or
29 percent
• The American population is aging and the prevalence of
chronic diseases is growing so the responsibility for
prevention and the implementation of long-term care
continues to shift to the individual.
Lack of Healthcare kills....
• According to Urban Institute, there are 27,000 preventable
deaths in America each year due to a lack of healthcare
• Uninsured people often postpone getting checked out by
doctors because they know it will be too expensive, and
often only seek care when it is too late. By that time, the
procedures necessary are far more costly.
Trying to End the Inequalities
In 2004 the Commonwealth Fund wrote a report outlining
steps to combat healthcare disparities:
• expanded access for minorities
• greater minority representation within the healthcare
workforce
• consistent racial and ethnic data collection by healthcare
providers
Citations
"Healthcare Coverage; Study asks if adults benefiting from state health insurance expansions." Life Science Weekly. 14 Feb 2006.
869. eLibrary. Proquest CSA. MOUNTAIN VIEW HIGH SCHOOL. 17 May 2009. <http://elibrary.bigchalk.com>.
Iglehart, John K. "Visions for Change in U.S. Health Care -- The Players and the Possibilities." New England Journal of Medicine. 15
Jan 2009. 205. eLibrary. Proquest CSA. MOUNTAIN VIEW HIGH SCHOOL. 21 May 2009. <http://elibrary.bigchalk.com>.
J. McDonough, B. Gibbs, J. Scott-Harris, K. Kronebusch, A. Navarro, and K. A. Taylor, "State Policy Agenda to Eliminate Racial
and Ethnic Health Disparities," Commonwealth Fund (June 2004).
Krugman, Paul. "Health Care Horror Stories." New York Times. 17 May 2009
<http://www.nytimes.com/2008/04/11/opinion/11krugman.html>.
Michael E. Makover, MD. "What's wrong with managed care and how to fix it." World & I. 01 Feb 2000. 299. eLibrary. Proquest
CSA. MOUNTAIN VIEW HIGH SCHOOL. 17 May 2009. <http://elibrary.bigchalk.com>.
Minnesota Council of Health Plans. "How Much Does It cost." mmhealthplans. 17
May 2009 <www.mnhealthplans.org/consumers/documents/
HowMuchDoesItCost2005.doc>.
Owen, William F Jr; Szczech, Lynda A; Frankenfield, Diane L. "Healthcare system interventions for inequality in quality:
Corrective action through evidence-based medicine." Journal of the National Medical Association. 8 2002. S83. eLibrary. Proquest
CSA. MOUNTAIN VIEW HIGH SCHOOL. 17 May 2009. <http://elibrary.bigchalk.com>.
Robert M. Hayes. "Preserve Medicare: The program could offer a solution to our nation's deepening healthcare crisis." Financial
Planning. 01 Jul 2006. eLibrary. Proquest CSA. MOUNTAIN VIEW HIGH SCHOOL. 17 May 2009. <http://elibrary.bigchalk.com>.
Sitkoff, Harvard. "Medicare and Medicaid." Postwar America: A Student Companion. n.p., Oxford University Press. 2000. n.pag.
eLibrary. Proquest CSA. MOUNTAIN VIEW HIGH SCHOOL. 17 May 2009. <http://elibrary.bigchalk.com>.
Ross, Johnathon S. "Health Reform Redux: Learning From Experience and Politics." American Journal of Public Health. 5 2009.
779. eLibrary. Proquest CSA. MOUNTAIN VIEW HIGH SCHOOL. 26 May 2009. <http://elibrary.bigchalk.com>.