Transcript Economics Perspective - University of South Carolina

Economics Perspective
on Health Care and Women in the
US
• [email protected]
• www.pnhp.org
Private market
for health services and health insurance
with an overlay of government spending
Who Pays for Healthcare?
Government
Amount in 1998
(billions)
$736.8
Medicare
$216.2
Medicaid
$170.6
Premiums for public employees
$67.3
Tax subsidy for private insurance
$124.8
Other*
$157.9
Percent
64.1%
Private employers
$216.5
18.8%
Individuals (excludes tax subsidy)
$195.8
17.0%
Total
$1149.1
100%
Source: Himmelstein & Woolhandler - Unpublished analysis of NCHS data, Health Affairs 1999;18(2):176
* Includes VA, NIH, subsidy for public hospitals, worker's comp, health departments etc.
U.S. Public Spending Per Capita for Health
is Greater than Total Spending in Other Nations
Note: Public includes benefit costs for govt. employees & tax subsidy for private insurance
Source: NEJM 1999; 340:109; Health Aff 2000; 19(3):150
Out-of-pocket payments, US and
world
Why Women Delay Prenatal Care
When They Know They Are Pregnant
47%
31%
22%
No money or insurance
Other reason
Unable to get appointment
Note: 11.1% of pregnant women failed to get timely prenatal care despite knowing they were
pregnant
Source: MMWR 5/12/2000; 49:393
Infant Mortality international
Infant Mortality
Infant Deaths by Income, Canada 1996
Even the Poor Do Better than U.S.
Average
9
8
7
6
5
4
3
2
1
0
7.8
6.5
4.7
5.1
5.2
3.9
Wealthiest
20%
Middle
20%
Poorest U.S.
20% Average
Maternal mortality
Life Expectancy For Women, 1997
»83
»82.3
»YEARS
»82
»81.3
»81
»80
»80.3
»79.4
»79
»78
»77
Source: OECD, 1999 & NCHS
»79.5
»81.4
»81.8
Poverty Rates, 1997
U.S. and Other Industrialized Nations
Source: Luxembourg Income Study Working Papers
Note: U.S. figure for 1997, other nations most recent available year
Americans Lead the World in Hours Worke
Source: International Labor Organization, 1999
Medical redlining
Illness and Medical Costs,
A Major Cause of Bankruptcy
•
45.6% of all bankruptcies involve a medical reason or large
medical debt
•
326,441 families identified illness/injury as the main reason for
bankruptcy in 1999
•
An additional 269,757 had large medical debts at time of
bankruptcy
•
7 per 1000 single women, and 5 per 1000 men suffered medicalrelated bankruptcy in 1999
Source: Norton's Bankruptcy Advisor, May, 2000
Uninsured women with breast
cancer, compared with the
insured:
• Have a 49% higher adjusted risk of death
• Are 1.4 x more likely to be diagnosed with
breast cancer at a late stage
Uninsured women, compared
with the insured, are:
• half as likely to have had both a
mammogram and clinical breast
examination in the previous 2 years
Uninsured women aged 50-64,
compared with the insured,
are:
• · 2.1 x less likely to have had a recent
mammogram
• · 1.9 x less likely to have had a recent Pap
test
• · 2.1 x less likely to have had a recent
clinical breast examination
Uninsured women aged 40-49,
compared with the insured,
are:
• · 1.5 x less likely to have had a recent
mammogram
• · 1.9 x less likely to have had a recent Pap
test
• · 1.9 x less likely to have had a recent
clinical breast examination
Uninsured pregnant women,
compared with the insured:
• Have a 31% higher likelihood of an adverse
hospital outcome
Federal Tax Subsidies for
Private Health Spending, 1998
ylimaF reP ydisbuS xaT
emocnI yB
$>
1
0
K0
01
0
K
$
7
-5
7
K5
5$
0
-
5
K0
4$
0
-
4
0
K
3$
0
-
3
0
K
2$
0
-
2
0
K
1$
5
-
1$
5
K
<
Family Income
$0
$500
$71
$296
$1000
$535
$1500
$2000
$2500
$3000
Note: Total federal tax subsidy = $111.2 billion
Source: Health Affairs 1999; 18(2):176
$847
$1195
$1684
$1971
$2357
Who Pays For Health Care?
Regressive U.S. Health Financing
INCOME DECILE
POOREST
RICHEST
emocnI fo erahS/stnemyaP htlaeH fo erahS
0
0.5
1
Regressive US financing
1.31
1.5
1.75
2
2.5
3
3
3.5
Source: Oxford Rev Econ Pol 1989;5(1):89
1.27
1.23
1.15
1.1
1.07
0.99
0.64
Progressive financing in Canada
(Province Of Alberta)
fo erahS/stnemyaP htlaeH fo erahS
emocnI
FAMILY INCOME
15,000
25,000
0.74
0.77
35,000
50,000
75,000
100 K
125 K
1.3
1.3
0
0.5
1
0.85
1
1.2
1.5
2
Source: Premier's Common Future Of Health, Excludes Out-of-Pocket Costs
Administrative Cost
Number of Insurance Products
Private insurers’ High Overhead
Milliman & Robertson
Pediatric Length of Stay Guidelines
• 1 Day for Diabetic Coma
• 2 Days for Osteomyelitis
• 3 Days for Bacterial Meningitis
“They're outrageous. They’re dangerous. Kids
could die because of these guidelines.”
Thomas Cleary, M.D. Prof. of Pediatrics, U. Texas, Houston
Listed as "Contributing Author" in M&R manual
Source: Modern Healthcare May 8, 2000:34
Milliman & Robertson
“We do not base our guidelines on any
randomized clinical trials or other
controlled studies, nor do we study
outcomes before sharing the evidence of
most efficient practices with colleagues.”
Wall Street Journal 7/1/98
Fraud
Can We Do Better? Yes!
•
•
•
•
Every other industrialized nation has a health
care system that assures medical care for all
All spend less than we do; most spend less than
half
Most have lower death rates, more accountability,
and higher satisfaction
Stories of shortages? If they had our system,
their problems would be much worse.
We Have What it Takes
•
Excellent hospitals, empty beds
•
Enough well-trained professionals
•
Superb research
•
Current spending is sufficient
What We Need:
•
To lead our leaders