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on Health Care and Women in the US
• www.pnhp.org
Economics Perspective
for health services and health insurance
with an overlay of government spending
Private market
Who Pays for Healthcare?
Source: Himmelstein & Woolhandler - Unpublished analysis of NCHS data, Health Affairs 1999;18(2):176* Includes VA, NIH, subsidy for public hospitals, worker's comp, health departments etc.
Amount in 1998(billions) Percent
Government $736.8 64.1%
Medicare $216.2
Medicaid $170.6
Premiums for public employees $67.3
Tax subsidy for private insurance $124.8
Other* $157.9
Private employers $216.5 18.8%
Individuals (excludes tax subsidy) $195.8 17.0%
Total $1149.1 100%
U.S. Public Spending Per Capita for Healthis Greater than Total Spending in Other Nations
Note: Public includes benefit costs for govt. employees & tax subsidy for private insuranceSource: NEJM 1999; 340:109; Health Aff 2000; 19(3):150
Out-of-pocket payments, US and world
Why Women Delay Prenatal CareWhen They Know They Are Pregnant
Source: MMWR 5/12/2000; 49:393
Note: 11.1% of pregnant women failed to get timely prenatal care despite knowing they werepregnant
47%
22%
31%
No money or insurance Unable to get appointment
Other reason
Infant Mortality international
Infant Deaths by Income, Canada 1996Even the Poor Do Better than U.S.
Average
3.94.7 5.1 5.2
6.5
7.8
012
3456
789
Wealthiest20%
Middle20%
Poorest20%
U.S.Average
Infa
nt
Mor
tali
ty
Maternal mortality
Life Expectancy For Women, 1997
Source: OECD, 1999 & NCHS
»81.8
»80.3
»82.3
»79.5
»81.3 »81.4
»79.4
»77
»78
»79
»80
»81
»82
»83
»U.S.
»U.K.
»GERM
ANY
»ITALY
»CANADA»SW
EDEN
»FRANCE
» YE
AR
S
Poverty Rates, 1997U.S. and Other Industrialized Nations
Source: Luxembourg Income Study Working PapersNote: U.S. figure for 1997, other nations most recent available year
Americans Lead the World in Hours Worked
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 medical-related 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 xmore 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 xless likely to have had a recent mammogram
1.9 xless likely to have had a recent Pap test
2.1 xless likely to have had a recent clinical breast examination
Uninsured women aged 40-49, compared with the insured,
are:
1.5 xless likely to have had a recent mammogram
1.9 xless likely to have had a recent Pap test
1.9 xless 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 forPrivate Health Spending, 1998
Note: Total federal tax subsidy = $111.2 billionSource: Health Affairs 1999; 18(2):176
$71$296
$535$847
$1195
$1684$1971
$2357
$0
$500
$1000
$1500
$2000
$2500
$3000
Family Income
Tax S
ubsidy Per F
amily
By Incom
e
Regressive US financing
Source: Oxford Rev Econ Pol 1989;5(1):89
3
1.75
1.311.271.231.151.11.070.99
0.64
0
0.5
1
1.5
2
2.5
3
3.5
POORESTRICHEST INCOME DECILE
Share of Health P
ayments/Share of Incom
eWho Pays For Health Care?
Regressive U.S. Health Financing
Source: Premier's Common Future Of Health, Excludes Out-of-Pocket Costs
0.740.770.851
1.21.31.3
0
0.5
1
1.5
2
15,00025,00035,00050,00075,000100 K125 K
FAMILY INCOME
Share of Health P
ayments/Share of
Income
(Province Of Alberta)
Progressive financing in Canada
Administrative Cost
Number of Insurance Products
Private insurers’ High Overhead
Milliman & RobertsonPediatric 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, HoustonListed 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