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Health Policy 2011Health Policy 2011
October 7, 2011 October 7, 2011
Deborah E. Trautman, PhD, RDeborah E. Trautman, PhD, RN N
Improving Health and Health Improving Health and Health CareCare
Improving Health and Health CareImproving Health and Health Care
Health ReformHealth Reform
National National StateState Local Local
Why Health Reform Anyway? Why Health Reform Anyway?
ExpensiveExpensive
IneffectiveIneffective
UnjustUnjust
Per Capita Total Current Health Care Expenditures, Per Capita Total Current Health Care Expenditures, U.S. and Selected Countries, 2008U.S. and Selected Countries, 2008
US spends twice as much as most other industrialized countries US spends twice as much as most other industrialized countries
^OECD estimate.
*Differences in methodology.
Notes: Amounts in U.S.$ Purchasing Power Parity, see www.oecd.org/std/ppp; includes only countries over $2,500. OECD defines Total Current Expenditures on Health as the sum of expenditures on personal health care, preventive and public health services, and health administration and health insurance; it excludes investment.
Source: Organisation for Economic Co-operation and Development. OECD Health Data 2010, from the SourceOECD Internet subscription database updated June 2010. Copyright OECD 2010, http://www.oecd.org/health/healthdata. Data accessed on 07/02/10.
2009 U.S. Health Care Spending4% increase$8,086 per person
Mortality Amenable to Health Mortality Amenable to Health CareCare
7681
88 84 89 8999 97
8897
109 106116 115 113
130 134128
115
65 71 71 74 74 77 80 82 82 84 84 90 93 96 101 103 103 104 110
0
50
100
150
Fran
ceJa
pan
Austra
liaSpa
inIta
lyCan
ada
Norw
ayNet
herla
nds
Swed
enG
reec
eAus
tria
Ger
man
yFi
nlan
dNew
Zea
land
Denm
ark
Unite
d Kin
gdom
Irela
ndPor
tuga
l
Unite
d Sta
tes
1997/98 2002/03
Deaths per 100,000 population*
* Countries’ age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial infections.
Data: E. Nolte and C. M. McKee, London School of Hygiene and Tropical Medicine analysis of World Health Organization mortality files (Nolte and McKee 2008).Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008.
Healthy Life Expectancy at Age 60 Healthy Life Expectancy at Age 60 20022002
2220 20 20 20 20 19 19 19 19 19 19 19 19 18 18 18 18 18 18 18 17 1718 17 17 16 17 17 16 16 16 16 16 16
1816 16 16 16 16 15 15 15 15
14
0
10
20
30 Women Men
Years
Note: Indicator was not updated due to lack of data. Baseline figures are presented. Data: The World Health Report 2003 (WHO 2003, Annex Table 4).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008
U.S. Health Spending as percent of GDP
(Health Care 18% 2011; 23% in 2012)
Pennsylvania Spending 2012
(Health Care 19% 2011; 33% in 2012)
25%
54%
36%
66%
48%
85%
Economic Problems WidespreadEconomic Problems Widespread Percent who report…Percent who report…
Uninsured (under age 65)
Lower income Americans
Problems payingmedical bills
Putting off needed care because of cost
All
Source: Kaiser Family Foundation Health Tracking Poll (conducted December 1-6, 2010)
Half Put Off Care Due to CostHalf Put Off Care Due to Cost
Percent who say they or another family member living in their Percent who say they or another family member living in their household, have done each of the following in the past 12 months household, have done each of the following in the past 12 months because of the cost:because of the cost:
52%
9%
15%
21%
21%
28%
32%
33%
Not filled a prescription for a medicine
Cut pills in half or skipped doses of medicine
Skipped dental care or checkups
Put off or postponed getting health care needed
Had problems getting mental health care
Relied on home remedies or over-the-counter drugs instead of going to see
a doctor
Skipped a recommended medical test or treatment
Source: Kaiser Family Foundation Health Tracking Poll (conducted March 8-13, 2011)
‘Yes’ to any of the above
Median out-of-pocket health care spending Median out-of-pocket health care spending as a percent of income continues to rise for as a percent of income continues to rise for
people on Medicare people on Medicare
SOURCE: Kaiser Family Foundation analysis of CMS Medicare Current Beneficiary Survey Cost and Use Files, 1997-2006.
11.9% 11.8% 12.0%12.8%
14.0%14.9%
15.6% 15.6%16.2%
15.5%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Total Medicare Population, 2008 = 45.0 Million
Nearly half of all Medicare beneficiaries live on Nearly half of all Medicare beneficiaries live on incomes below twice the federal poverty level, incomes below twice the federal poverty level,
20082008
35%
12% 11%
34% 35%
17%
21%
16% 15%
23%
19%14%
11%
15%
12%12%
11%
16%16%
12%
11%
47%
67%
41%
67%70%
57%
42%
150-199% of Poverty
100-149% of Poverty
<100% of Poverty
NOTES: Numbers may not sum to total due to rounding. In 2008, the federal poverty level was $10,400 for an individual and $14,000 for a couple. SOURCE: Kaiser Family Foundation analysis of the 2008 Current Population Survey and Medicare administrative data.
Age in Years Race/Ethnicity
Under age 65 disabled
Age 65+
White Black Hispanic
Asian Total
Average Annual Health Insurance Premiums and Average Annual Health Insurance Premiums and Worker Contributions for Family Coverage, Worker Contributions for Family Coverage,
2009-20112009-2011
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2009-2011.
$13,375 $13,770$15,073
$9,860 $9,773 $10,944
$3,515 $3,997$4,129
2009 2010 2011
Worker Contribution
Employer Contribution
Health Insurance Coverage in the U.S., 2009Health Insurance Coverage in the U.S., 2009
NOTE: Includes those over age 65. Medicaid/Other Public includes Medicaid, CHIP, other state programs, military-related coverage, and those enrolled in both Medicare and Medicaid (dual eligibles). SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on the Census Bureau's March 2010 Current Population Survey.
Total = 303.3 million
Number of Nonelderly Uninsured Americans,2000 – 2009
* The Census Bureau periodically revises its CPS methods, which means data before and after the revision are not comparable. Comparison across years can be made between 2000 through 2004, and 2004 though 2009.SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2001-2010 ASEC Supplements to the CPS.
Characteristics of the Uninsured, Characteristics of the Uninsured, 20092009
400% FPLand Above
10%
251-399% FPL 13%
100-250% FPL38%
<100% FPL40%
Family IncomeFamily Work Status
Total = 50.0 million uninsured
1 or More Full-Time Workers
61%
No Workers
23%
Part-TimeWorkers
16%
Age
55-6410%
35-5433%
19-3440%
0-1817%
The federal poverty level was $22,050 for a family of four in 2009. Data may not total 100% due to rounding. SOURCE: KCMU/Urban Institute analysis of 2009 ASEC Supplement to the CPS.
Non-Elderly Uninsured Non-Elderly Uninsured 2008/20092008/2009
PA US
Uninsured 1,286,800 49,997,900
Barriers to Health Care Among Nonelderly Barriers to Health Care Among Nonelderly Adults, by Insurance Status, 2009Adults, by Insurance Status, 2009
6%
4%
6%
11%
13%
9%
6%
11%
27%
26%
42%
55%
Could Not AffordPrescription
Drug*
Went WithoutNeeded Care Due
to Cost*
No PreventiveCare
No Usual Sourceof Care
Uninsured
Medicaid/ Other Public
Employer/ Other Private
* In past 12 months.Respondents who said usual source of care was the emergency room were included among those not having a usual source of care.SOURCE: KCMU analysis of 2009 NHIS data.
Percent of adults (age 18 – 64) reporting:
Geographic Variation in Health Care Geographic Variation in Health Care SpendingSpending
Source: Congressional Budget Office based on data from the Centers for Medicare and Medicaid Services (February 2008)
Relationship Between Quality of Care and Medicare Relationship Between Quality of Care and Medicare Spending:Spending:
As Expressed by Overall Quality Ranking 2000–2001As Expressed by Overall Quality Ranking 2000–2001
Data: Medicare administrative claims data and Medicare Quality Improvement Organization program data. Adapted and republished with permission of Health Affairs from Baicker and Chandra, “Medicare Spending, The Physician Workforce, and Beneficiaries’ Quality of Care” (Web Exclusive), 2004.
PennsylvaniaPennsylvania Facts At A Glance (KFF, 2008/2009)Facts At A Glance (KFF, 2008/2009)
PA US MD
Total Population 12,286,700 303,343,300 5,586,700
% Living in Poverty
16 20 15
Health Spending per capita
5,933 5,283 5,590
% Uninsured 11 17 13
Rate of unemployment
7.5 9.0 6.8
PennsylvaniaPennsylvania Facts At A Glance Facts At A Glance (KFF, 2008/2009)(KFF, 2008/2009)
PA US MD
Health status
Infant Mortalityper 1000 births
7.4 6.8 7.9
Teen Death Rate per 100,000
59 62 67
AIDS per 100,000 7.3 11.2 19.9
Overweight or Obese
29.7 31.6 28.8
The National Perspective The National Perspective Patient Protection and Affordable Care Act (ACA)
Signed into Law March 23, 2010; Changes adopted March 30, 2010
Feelings About Health Reform Fairly StableFeelings About Health Reform Fairly StablePercent who say that each of the following describes their feelings about the health Percent who say that each of the following describes their feelings about the health reform law:reform law:
55%
44% 42%43% 45%
53%
47%52%
43%
50%53%
0%
20%
40%
60%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
CONFUSED
30% 30% 31%28%
31% 32%28%
32% 30%34% 34%
0%
20%
40%
60%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
ANGRY
30% 30% 30%35% 33% 31%
27%
0%
20%
40%
60%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
ENTHUSIASTIC
2010
2010
2010
42%
36%
42%39% 39%
0%
20%
40%
60%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
ANXIOUS
2010
2011
Source: Kaiser Family Foundation Health Tracking Polls
2011
2011
2011
Negative Views Driven by Many FactorsNegative Views Driven by Many FactorsI’m going to read some reasons people give for viewing the law unfavorably. After I read I’m going to read some reasons people give for viewing the law unfavorably. After I read each one, please tell me if it is a major reason, a minor reason, or not a reason why you each one, please tell me if it is a major reason, a minor reason, or not a reason why you yourself have an unfavorable view of the law.yourself have an unfavorable view of the law.
46%
72%
73%
75%
79%
82%
AMONG THOSE WHO OPPOSE THE HEALTH CARE LAW, percent who say each is a MAJOR reason for opposing:
Source: Kaiser Family Foundation Health Tracking Poll (conducted August 16-22, 2010)
We can’t afford to pay for health care reform right now
The law gives government too big a role in the health care system
The law doesn’t go far enough in expanding coverage or controlling costs
Too much of the process took place behind closed doors and involved too much deal-making
The law takes the wrong approach to reform
Health reform is just one of many indications that President Obama and the Democrats in Congress are
taking the country in the wrong direction
52%
26%
22%
It is still the law of the
land
Don’t know/
Refused
One in Five Think the Health Law Has Been Repealed, One in Five Think the Health Law Has Been Repealed, Another Quarter Not SureAnother Quarter Not Sure
As far as you know, which comes closest to describing the current As far as you know, which comes closest to describing the current status of the health reform law that was passed last year:status of the health reform law that was passed last year:
It has been repealed and is no longer
law
48%
Source: Kaiser Family Foundation Health Tracking Poll (conducted February 3-6, 2011)
Majority Want to Keep Major Elements of Law, Majority Want to Keep Major Elements of Law, Except for Individual MandateExcept for Individual Mandate
I'm going to read you several elements of the health reform law. For each, please tell me if I'm going to read you several elements of the health reform law. For each, please tell me if you think lawmakers should keep it or repeal it.you think lawmakers should keep it or repeal it.
27%
58%
72%
74%
76%
82%
67%
36%
24%
22%
19%
15%
Keep Repeal
Tax credits to small businesses
Individual mandate
Increase Medicare payroll tax on wealthy
Guaranteed issue
Gradually close the Medicare “doughnut hole”
Financial help for low and moderate income Americans in need of coverage
Note: Question responses abbreviated. See Topline: http://www.kff.org/kaiserpolls/8166.cfm for complete wording. Keep it but make changes (vol.) and Don’t know/Refused answers not shown. Source: Kaiser Family Foundation Health Tracking Poll (conducted March 8-13, 2011)
$5,63024%
$12,50049%
The Ryan Plan Health Care Spending as a Share of Social Security Income for a
Typical 65-Year-Old Medicare Beneficiary, 2022
Average Social Security Income, 2022$25,560 $25,560
Beneficiary Spending as a share of
Social Security Payment
SOURCE: Kaiser Family Foundation analysis. Beneficiary health care spending under Medicare (extended baseline scenario) and Mr. Ryan’s proposal is calculated based on data in the CBO letter to Chairman Paul Ryan dated April 5, 2011. Social Security income for an average wage 65-year old retiring at age 65 is based on Social Security Administration data (Table VI.F10 of the 2010 Trustees Report) adjusted to current dollars (based on annual CPI projections in Table VI.F6. See http://www.ssa.gov/OACT/TR/2010/lr6f6.html factors).
Traditional Medicare “Path to Prosperity” Proposal
Little Appetite For Spending Reductions In Social Little Appetite For Spending Reductions In Social Security And MedicareSecurity And Medicare
If Congress decides to reduce the deficit by reducing federal spending, I’d like to know in which areas If Congress decides to reduce the deficit by reducing federal spending, I’d like to know in which areas you would be willing to see spending reduced. For each area I name, please tell me if you would you would be willing to see spending reduced. For each area I name, please tell me if you would support major spending reductions, minor spending reductions or no reductions at all as a way to support major spending reductions, minor spending reductions or no reductions at all as a way to reduce the federal deficit. reduce the federal deficit.
30%
48%
59%
62%
37%
36%
30%
28%
30%
14%
10%
9%
Medicare
Defense
Social Security
Medicaid
NO reductions
Support MAJOR reductions
Support MINOR reductions
Note: Don’t know/Refused answers not shown. Source: Kaiser Family Foundation Health Tracking Poll (conducted July 13-18, 2011)
The Patient Protection and The Patient Protection and Affordable Care ActAffordable Care Act
To make insurance more accessible and To make insurance more accessible and affordableaffordable Increases the number of Americans with health Increases the number of Americans with health
insurance through the expansion of public insurance through the expansion of public programs and changes in health insurance. programs and changes in health insurance.
Covers 32 of the 50 million uninsured. Covers 32 of the 50 million uninsured. To improve health and healthcare To improve health and healthcare
Health Reform
Changing our Mindset and Philosophy of Care
The Right Care
The Right Time
The Right Place
The Right Price
Patient-Centered, Integrated
Care Delivery, Organized around
Population and Disease
PrimaryCare
Specialists
AmbulatoryCare
HomeCare
CommunityServices
HospitalCare
Improving the Delivery SystemImproving the Delivery System
Comparative Effectiveness ResearchComparative Effectiveness Research Patient Centered Medical HomePatient Centered Medical Home Accountable Care Organizations Accountable Care Organizations Investments in Health Information Investments in Health Information
TechnologyTechnology Payment reforms – bundlingPayment reforms – bundling Reductions in hospital readmissionsReductions in hospital readmissions
The ChallengeThe Challenge
The Triple AimThe Triple Aim
Better CareBetter Care
Better HealthBetter Health
Lower CostLower Cost
Donald Berwick, MD Administrator, Centers for Medicare and Donald Berwick, MD Administrator, Centers for Medicare and Medicaid Services Medicaid Services
Center for Medicare and Medicaid Center for Medicare and Medicaid InnovationInnovation
10 billion over 10 years for promising practices, 10 billion over 10 years for promising practices, innovations in delivery system reforminnovations in delivery system reform
$5 million in 2010$5 million in 2010 Acting Director- Rick Gilfillan MD (former CMO of Acting Director- Rick Gilfillan MD (former CMO of
Geisenger Health)Geisenger Health) Focus on care delivery models, integration, and Focus on care delivery models, integration, and
population healthpopulation health Transitional Models of Care (Dr. Mary Naylor)Transitional Models of Care (Dr. Mary Naylor) Health Innovation ZonesHealth Innovation Zones
The Patient Protection and The Patient Protection and Affordable Care ActAffordable Care Act
What is What is notnot in the law in the law Price SettingPrice Setting Death PanelsDeath Panels Cost Effectiveness over QualityCost Effectiveness over Quality Disrupting patient/provider relationshipDisrupting patient/provider relationship Disrupting access to insurance coverageDisrupting access to insurance coverage Government takeoverGovernment takeover Increasing the deficitIncreasing the deficit
Will reform lead to better health Will reform lead to better health and health care? and health care?
Implementation for Implementation for Pennsylvania, Maryland Pennsylvania, Maryland
and the USand the US (Families USA 2010) (Families USA 2010)PA US MD
Uninsured Adults on parents plan
89,100 3,440,000 55,600
Medicare Beneficiaries prescription drug rebate
247,400 3,665,000 54,700
Free preventive services
2,261,100 45,918,500 775,700
Children with preexisting conditions
177,900 4,952,100 88,600
Small businesses and tax credit
160,700 4,015,300 66,000
Under the health reform law, do you think each of the following will get Under the health reform law, do you think each of the following will get better, worse or will it stay about the same? better, worse or will it stay about the same?
28%
26%
20%
49%
18%
28%
37%
23%
49%
41%
37%
24%
The quality of health care in the nation
The cost of health care for the nation as a whole
Consumer protections for the average person with private
health insurance
Access to health care for the uninsured
Note: Items asked of half sample. Don’t know/Refused answers not shown. Source: Kaiser Family Foundation Health Tracking Poll (conducted July 13-18, 2011)
Get better
Stay about the same
Get worse
Half Expect Access For Uninsured To Get Better, Half Expect Access For Uninsured To Get Better, But Fewer Think The Same About Consumer But Fewer Think The Same About Consumer Protections, Quality Or Costs For The NationProtections, Quality Or Costs For The Nation
Health Reform in Pennsylvania Health Reform in Pennsylvania
Quality of careQuality of care Hospital payment reformHospital payment reform Patient centered medical homePatient centered medical home Health information technologyHealth information technology AccessAccess
Health Reform in Health Reform in PennsylvaniaPennsylvania The Office of Health Care Reform and the Health The Office of Health Care Reform and the Health
Care Reform Cabinet Care Reform Cabinet were established by were established by executive order in January 2003 with the goal of executive order in January 2003 with the goal of improving accessibility, affordability and quality improving accessibility, affordability and quality of health and long-term living services in of health and long-term living services in Pennsylvania. Since then, the Office has worked Pennsylvania. Since then, the Office has worked with the Cabinet and key stakeholders to create with the Cabinet and key stakeholders to create the Prescription for Pennsylvania – a the Prescription for Pennsylvania – a comprehensive plan to restructure the comprehensive plan to restructure the commonwealth’s health care system. commonwealth’s health care system.
Distinct Differences and Distinct Differences and Common Challenges Common Challenges
Beginning Premise Beginning Premise Patient Care Delivery is a Patient Care Delivery is a
ScienceScience
6 competencies to transform systems 6 competencies to transform systems are not linear but are broad and are not linear but are broad and
overlappingoverlapping
Informatics
Quality
improvement
Patient centered
care
EvidenceBased
practice
Safety
Teamwork
And
collaboration
Denise Hirst, MSN, RNwww.unc.edu Fall 2008
American College of Radiology American College of Radiology ACR ACR
http://www.acr.orghttp://www.acr.org
Health Policy ResearchHealth Policy Research Practice of Radiology in the U.S. Practice of Radiology in the U.S. Workload and Productivity Workload and Productivity Compensation for Radiologists Compensation for Radiologists Demographics and Practice CharacteristicsDemographics and Practice Characteristics Employment Market for Radiologists Employment Market for Radiologists Utilization of Imaging Utilization of Imaging Published Papers Published Papers Frequently Asked Research QuestionsFrequently Asked Research Questions
It Will Take All of Us!It Will Take All of Us!
RWJF Gallup Survey 2010
Who Will Influence Health Reform in the Who Will Influence Health Reform in the United States in the Next 5-10 YearsUnited States in the Next 5-10 Years
Thinking about the next five to ten years, how much influence do you think each of the following professions or groups of people will have in health reform in the United States?
OpportunitiesOpportunities
Increased visibility, participation and Increased visibility, participation and influence in the health policy processinfluence in the health policy process
““If you are not at the table, you are likely If you are not at the table, you are likely to be on the menu” (Zerhouni, 2008)to be on the menu” (Zerhouni, 2008)
The Center for Health Policy and The Center for Health Policy and
Healthcare TransformationHealthcare TransformationDeborah E. Trautman, PhD, RNDeborah E. Trautman, PhD, RN
Executive Director Executive Director
Johns Hopkins MedicineJohns Hopkins Medicine
Center for Health Policy and Healthcare TransformationCenter for Health Policy and Healthcare Transformation
Email: [email protected]: [email protected]
3910 Keswick Road, Suite N22003910 Keswick Road, Suite N2200
Baltimore, Maryland 21211Baltimore, Maryland 21211
443-997-0735443-997-0735
1717 Massachusetts Avenue NW/Room 6031717 Massachusetts Avenue NW/Room 603
Washington, DC 20036 Washington, DC 20036
410 -206-1230410 -206-1230
