Health and Health Care

An American Dream

Dr. Susan G. Rucker

Purpose of Presentation

To address the negative financial, social and personal consequences

That result from lacking health insurance and health care access.

To call your organization to action

What is Health?

Health is the absence of disease and attainment of well-being.

Health care is the activities related to keeping community members healthy, preventing disease progression, and treating the sick.

What is our health care system?

Emergency careHigh technology Life-prolongingPrescriptionsCutting-edgeExpensiveDifficult to access for prevention

Influencers of Health1. Behaviors and decisions that

affect individuals and families2. Decisions made by community

leaders regarding resources, promotion, and protection

3. Environment within the community that supports and facilitates healthful decisions

United Health Foundation – www.unitedhealthfoundation.org/shr2003/index.html

Health StatisticsUnited States

290,000,000 People $1.6 Trillion Expenditures For Health Care$5,440 per person average spending 9.3% Increase in spending in 2002 (mostly RX and hospital)

43 Million Uninsured

Kaiser Foundation Report: “Cost of not covering the uninsured”Sunherald.com Hospital spending and Rx

GDP Health Spending

0 50 100

Percent of Health Spending of Gross Domestic Product

1993

2001

2014

Health StatisticsCharlotte/Mecklenburg, NC

746,000 population17% uninsured120,000 people uninsured

Apprx : Mecklenburg County Health Dept 2002-NC DHHS/State Center for Health Statistics

Causes of DeathCost of Choice

Smoking#1 cause of preventable death

Obesity#2 cause of preventable death$2.1 Billion obesity and related illnesses$428 Million in Mecklenburg

Prevention Partners

Causes of DeathCharlotte/Mecklenburg, NC

1,100 Heart Disease1,000 Cancer350 Stroke/CVD207 Chronic Lower Respiratory

204 Accidental Injuries144 Alzheimer’s 114 Diabetes100 FluOther

Apprx : Mecklenburg County Health Dept 2002 Nation closely resembles local statistics

Approx. 4,600 Deaths Per Year

Behaviors, Decisions & Health

If80% of diseases are preventable

CouldA 50% reduction preventable diseases

TherebyReduce health care costs by 50%

?

Probably Not

Choice -PersonalAccess

Choice

Smoking EatingHelmetsSexDrugsRock ‘n Roll

Acce$$

LocationCommunicationTransportationKnowledge

Ability to pay

How Do We Pay for Health Care?

1. Insurance – Negotiated rates

2. Uninsured – Self-pay or Charity

Insurance

1. Medicare2. Medicaid3. Private Insurance

1. Medicare

Age 65 and older

2. Medicaid

Less than age 18 Older than 65Specially Qualified

PregnantDisabledBlind

Not an automatic safety-net for the poor

$4,000 annual income does not necessarily qualify for MA

2004 HHS Poverty Guidelines

Size of Family

Unit

February 2003

Guidelines 125% 150% 185% 200%1 9,310$ 11,638$ 13,965$ 17,224$ 18,620$ 2 12,490$ 15,613$ 18,735$ 23,107$ 24,980$ 3 15,670$ 19,588$ 23,505$ 28,990$ 31,340$ 4 18,850$ 23,563$ 28,275$ 34,873$ 37,700$ 5 22,030$ 27,538$ 33,045$ 40,756$ 44,060$ 6 25,210$ 31,513$ 37,815$ 46,639$ 50,420$ 7 28,390$ 35,488$ 42,585$ 52,522$ 56,780$ 8 31,570$ 39,463$ 47,355$ 58,405$ 63,140$

3. Private InsuranceEmployer provided – Not mandatedTrends:

Decreasing coverage in large businessIncrease co-pay/deductibleInability of small business to afford to offer coverageIncrease in businesses that will not offer coverageEliminating non-employee coverage spouse, child, partner, etc.

Insurance Coverage for Non-Elderly Population 2002

Employer sponsored

64%

Private non-group5%

Medicaid14%

Uninsured17%

Source: Kaiser Commission on Medicaid and the Uninsured

Uninsured

Why is this so important?

Fact About the Uninsured

•8 out of 10 are from working families

•70% have one or more full-time workers

•Near poor have greatest risk of becoming uninsured (<200% Federal Poverty Level)

•64% of the uninsured are low-income individuals or from low-income families

•80% are American citizens

•Trend of un insurance is increasing; especially in small businesses

Ages of the Uninsured 2002Non Medicare -- United States

Adults 55-64 Under age

19

Adults 19-34

Adults 35-54

Source: Kaiser Commission on Medicaid and the Uninsured and Urban Institute on March 2003 Current Population survey

Income of the Uninsured 2002 Non Medicare -- United States

200-299%FPL 300% FPL +

<100% FPL

100-199% FPL

Source: Kaiser Commission on Medicaid and the Uninsured and Urban Institute on March 2003 Current Population survey

Work Status of the Uninsured 2002Non Medicare -- United States

No Workers

1 Full-time

2 + Full-time

Part-time workers

Source: Kaiser Commission on Medicaid and the Uninsured and Urban Institute on March 2003 Current Population survey

UninsuredLength of Time -- United States

6-12 mo25%

>12 mo53%

�

< 6 mo22%

Anytime in one year 49 millionSource: Kaiser Commission on Medicaid and the Uninsured

26 million 11 million

12 million

Uninsured-Information

Less prevention Higher acuity Higher mortality rateLower earnings

Costly late stage treatment5-15% increased mortality than insured10-30% reduction in earnings and educationKaiser Commission on the Uninsured 2003

• 43 Million People Nationally• 10% Growth 2000-2002• One in Seven Americans

UninsuredCost of office-care versus hospitalizations

Bacterial pneumoniaDiabetes complicationsCongestive heart failureLow birth weightAdult asthma complications

HCC Research

12% of hospital costs of caring for uninsured are a result preventable complications

Questions of economic benefit to government and individuals

Uninsured average $1,253/year and receive ½ as much careInsured average $2,484$35 Billion in uncompensated care, $30 Billion is government paid

Kaiser Commission 6/03 report

Covering the UninsuredCost to increase coverage

+$34 B public standard coverage or+$69 B private standard coverage

Added to total current $99 BTotals $133 B to $168 B

Added to 1.6 Trillion currently spent

Overall impact 3-6% increase in total health care spending

Kaiser Commission 6/03

Uninsured- Providing CareCommunity Health ServicesMedAssistCharlotte Community Health ClinicUNCC Center for Health PromotionFree clinics of Our Towns

Metrolina Community Health Center Volunteer In Medicine Clinics Project Health ShareMecklenburg County Medical SocietyUNCCCarolinas Medical

Providing Care

Matthews Health CenterLank Norman Free ClinicAdd your efforts

Add

Purpose of Presentation

To address the negative financial, social and personal consequences

That result from lacking health insurance and health care access.

To call your organization to action

Cover the UninsuredWeek

May 10-16

What Can You Do?

Know where to refer someoneKnow issuesInfluence legislatorsSupport community efforts

ClinicsFamilies

Resources

www.iom.edu Institute of Medicinewww.ncpa.orgwww.aha.orgwww.hrsa.govwww.kff.org Kaiser Family Foundation

Extra Slides

The System

“Dodging sick people is expensive business…”

Marcia Angell, MD Harvard Medical School for ANA News 4/7/2003

Health Is

EconomicsMedicinePoliticsResponsibility

Our House

“What happens in our house is more important than what happens in the White House.”

Barbara Bush