Embed Size (px)
Citation preview
Health Insurance in the United StatesHealth Insurance in the United StatesPresented by: A. Gaffer Erbek, Zak Horn, Anthony Sarnecki Presented by: A. Gaffer Erbek, Zak Horn, Anthony Sarnecki
AgendaAgenda
Current State of Health in USCurrent State of Health in US US Health Care SystemUS Health Care System Types of Health CareTypes of Health Care Current Spending LevelsCurrent Spending Levels Trends in SpendingTrends in Spending FraudFraud Future of HealthcareFuture of Healthcare
Current State of Health in the USCurrent State of Health in the US
Current State of Health in the USCurrent State of Health in the US
United States is AgingUnited States is Aging
Life Expectancy at BirthLife Expectancy at Birth
COUNTRYCOUNTRY MALEMALE FEMALEFEMALE
JapanJapan 7777 83.683.6
CanadaCanada 75.475.4 81.681.6
United KingdomUnited Kingdom 74.474.4 79.379.3
GermanyGermany 73.673.6 79.979.9
United StatesUnited States 72.772.7 79.479.4
US Health Care SystemUS Health Care System
United States distinctive in several ways:United States distinctive in several ways: Much larger portion of GDP spent on health care than Much larger portion of GDP spent on health care than
other developed countriesother developed countries Majority of global health care innovation is a result of Majority of global health care innovation is a result of
research and development from the United Statesresearch and development from the United States Formal insurance coverage is not universal in the United Formal insurance coverage is not universal in the United
StatesStates Elderly and poor rely on the governmentElderly and poor rely on the government Most others depend on their employersMost others depend on their employers
How is Health Care Provided?How is Health Care Provided?
Public/Social ProgramsPublic/Social Programs MedicareMedicare MedicaidMedicaid
CorporateCorporate Benefit plansBenefit plans PensionsPensions
IndividualIndividual Self employedSelf employed
No coverage – pay as you goNo coverage – pay as you go
Breakdown of CoverageBreakdown of Coverage
Current Expenditure LevelsCurrent Expenditure Levels
Per Capita Spending (2002)Per Capita Spending (2002) United States: $5,267 [Highest]United States: $5,267 [Highest] Switzerland: $3,446 [2Switzerland: $3,446 [2ndnd Highest] Highest] Global median: $2,193Global median: $2,193
Percent of GDPPercent of GDP United States: 14.6%United States: 14.6% Only two other countries over 10%Only two other countries over 10%
GermanyGermany SwitzerlandSwitzerland
Source: Anderson, et al, Health Affairs, Jul/Aug 2005, Vol. 24, Issue 4, pg. 903
Proffessor Jefrey R.Brown, Employee Benefits.
Expenditures per GDPExpenditures per GDP
Breakdown of ExpendituresBreakdown of Expenditures
Spending Growth is HighSpending Growth is High
Health Care spending is growing faster than Health Care spending is growing faster than GDP in most countriesGDP in most countries
United States: Grew from 13% (1992) to 14.6% (2002)United States: Grew from 13% (1992) to 14.6% (2002) Increase is twice the growth of other OECD medianIncrease is twice the growth of other OECD median
Note: Increase occurred during a time when managed care Note: Increase occurred during a time when managed care and increase cost sharing were credited for holding and increase cost sharing were credited for holding spending down in the United Statesspending down in the United States
What causes growth in costs?What causes growth in costs?
Technological progressTechnological progress Rising incomeRising income Increased third party paymentsIncreased third party payments Aging populationAging population More doctorsMore doctors More expensive illnessesMore expensive illnesses Increasing malpractice awardsIncreasing malpractice awards Easy AccessEasy Access
Note: Average cost of a day spent in a hospital (2002)Note: Average cost of a day spent in a hospital (2002) United States: $2,434United States: $2,434 Canada: $870Canada: $870
Prescribed Medicine ExpensePrescribed Medicine Expense
Fraud and AbuseFraud and Abuse
Fraud increases costs by as much as 15%Fraud increases costs by as much as 15% Priority for public and private insurersPriority for public and private insurers Increasingly complex schemesIncreasingly complex schemes HIPAA Act of 1996HIPAA Act of 1996 Qui TamQui Tam Blue Cross / Blue Shield lead the chargeBlue Cross / Blue Shield lead the charge Considerable investment in IT resources to Considerable investment in IT resources to
identify fraudidentify fraud
Who’s Responsible ?Who’s Responsible ?
PhysiciansPhysicians Large publicly traded companiesLarge publicly traded companies Medical equipment dealersMedical equipment dealers LaboratoriesLaboratories HospitalsHospitals Nursing HomesNursing Homes Home health care agenciesHome health care agencies Contract carriers for Medicare and MedicaidContract carriers for Medicare and Medicaid PharmaciesPharmacies Individual scam artistsIndividual scam artists Other unscrupulous, dishonest and generally unpleasant peopleOther unscrupulous, dishonest and generally unpleasant people
Future of Health CareFuture of Health Care
US Health care costs could consume up to 20% US Health care costs could consume up to 20% of GDP by 2010of GDP by 2010
Booming health care industry: West grows old Booming health care industry: West grows old and the East is transformed by exploding middle and the East is transformed by exploding middle classclass
Advances continue to expand average life span, Advances continue to expand average life span, driving changes in health care insurance driving changes in health care insurance philosophyphilosophy
Health care moves out of the hospitalHealth care moves out of the hospital
Costs increase, benefits decreaseCosts increase, benefits decrease
Private insurers:Private insurers: Cut costsCut costs Aggressively pursue fraudAggressively pursue fraud Reduce benefitsReduce benefits Increase screening for “high risk” policy holdersIncrease screening for “high risk” policy holders
Government:Government: DOJ will step up enforcementDOJ will step up enforcement Considerable expenditures on IT / technologyConsiderable expenditures on IT / technology
Individuals:Individuals: Number of uninsured will growNumber of uninsured will grow Policies with high deductibles and reduced benefits are Policies with high deductibles and reduced benefits are
becoming popularbecoming popular
Questions?Questions?
