Health Care Policy. Introduction. Assessing health care efficacy

Transcription

1 Health Care Policy tions/chartbooks/2014/multinationalcomparisons-of-health-systems-data-2014 Introduction Why health care policy matters The problem in (sort of) 3 charts Assessing health care efficacy 1

2 Health in America Life Expectancy US vs. the world Emphasis on elderly Health care vs. health Infant Mortality Life expectancy after 80 The U.S. Health Care System Complexity of system 2

3 The U.S. Health Care System Fee for Service Managed Care Government subsidized care Problems with the U.S. System: Cost High relative cost 16 Health Care Spending per Capita by Source of Funding, 2012 Adjusted for Differences in Cost of Living 8,745 6,080 4,811 4,698 4,602 4,288 4,106 3,997 3,289 3,172 * Source: OECD Health Data Pharmaceutical Spending per Capita, 2012 Adjusted for Differences in Cost of Living Health Care and GDP 2008 OECD data * Source: OECD Health Data

4 Percent Health and Social Care Spending Percent of GDP 19 Problems with the U.S. System: Cost Source: E. H. Bradley, L. A. Taylor, and H. V. Fineberg, The American Health Care Paradox: Why Spending More is Getting Us Less, Public Affairs, Fee-for-service system Technology Market Failure Aging public Medical culture Prescription Drugs Administrative costs It s the prices, stupid What it is not Price level Retail Price Indexes for Basket of In-Patent Pharmaceuticals, 2010 US is set at Diagnostic Imaging Prices, 2013 MRI CT Scan (abdomen) 22 Note: Calculations weighted relative to U.S. consumption patterns. U.S. retail prices were discounted from manufacturer prices according to the rebates obtained by the Medicaid program. Source: P. Kanavos, A. Ferrario, S. Vandoros et al., "Higher U.S. Branded Drug Prices and Spending Compared to Other Countries May Stem Partly from Quick Uptake of New Drugs," Health Affairs, April (4): Notes: US refers to the commercial average. MRI refers to magnetic resonance imaging; CT refers to computed tomography. Source: International Federation of Health Plans, 2013 Comparative Price Report. Total Hospital and Physician Costs, 2013 Appendectomy Bypass Surgery 23 Spending on Health Insurance Administration per Capita, 2012 Adjusted for Differences in Cost of Living Notes: US refers to the commercial average. Appendectomy prices reflect a blend of inpatient and outpatient prices based on relative utilization in each setting. Source: International Federation of Health Plans, 2013 Comparative Price Report. * Source: OECD Health Data

5 Spending per Hospital Discharge, 2012 Adjusted for Differences in Cost of Living 25 Physician Incomes, 2008 Adjusted for Differences in Cost of Living 26 Orthopedic surgeons Primary care doctors * ** Source: OECD Health Data Source: M. J. Laugesen and S. A. Glied, Higher Fees Paid to U.S. Physicians Drive Higher Spending for Physician Services Compared to Other Countries, Health Affairs, Sept (9): Problems with the U.S. System: Access Inadequate Access Why so many uninsured? Maldistribution of resources Employer-based issues Rationing 5

6 Rationing the wait Wait Times for Specialist Appointment 35 Less than four weeks Two months or more 100 Percent Base: Needed to see specialist in the past two years. Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries. 6

7 Problems with the U.S. System: Quality Quality in cross-national perspective 7

8 Mortality Amenable to Health Care 44 Deaths per 100,000 population* FR AUS ITA JPN SWE NOR NETH AUT FIN GER GRE IRL NZ DEN UK US * Countries age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial infections. Analysis of World Health Organization mortality files and CDC mortality data for U.S. Source: Adapted from E. Nolte and M. McKee, Variations in Amenable Mortality Trends in 16 High-Income Nations, Health Policy, published online Sept. 12,

9 Percent Breast Cancer Five-Year Relative Survival Rate, (or nearest period) 49 Source: OECD Health Data Problems with the U.S. System: Quality Lack of Access Focus on sickness instead of health Overspecialization Inpatient Coronary Bypass Grafts per 100,000 Population, Magnetic Resonance Imaging (MRI) Exams per Million Population, * ** Source: OECD Health Data * ** Source: OECD Health Data

10 Contemporary Policy Medicare Medicare Prescription Drug benefit Medicaid Other Policies (S/CHIP) Affordable Care Act/ ObamaCare Goals Basics/Three-legged stool Federal/state issues Money What it s not Assessment 10

11 Further reform? Lessons from abroad The long-term cost problem 11