Health Care Reform: Challenges and Opportunities
Marian Mulkey, MPP, MPHCalifornia HealthCare Foundation
www.chcf.org
State Association of County Retirement SystemsSpring Conference
May 15, 2009
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The Problems
Rising health care costs Growing population of uninsured Declining rate of employer-sponsored
insurance Ongoing concerns with health care quality
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Health spending represents a growing share of the US economy.
Slide #3 of HC Costs 101, 2008
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In the US, health care spending is split between private and public sector.
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Most non-elderly Californians receive health coverage through employment…
Source: California HealthCare Foundation, Snapshot: California’s Uninsured, 2008.
Subsitute Slide 4, Unins snapshot 2008
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Yet employer-based coverage is steadily declining, and more are uninsured.
Source: California HealthCare Foundation, Snapshot: California’s Uninsured, 2008. www.chcf.org/documents/insurance/CAUninsured08.pdf
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The uninsured are less likely to get the care they need.
Source: Kaiser Family Foundation, The Uninsured: A Primer, October 2006
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Adherence to Quality Indicators
10.5%
22.8%
32.7%
40.7%
45.2%
45.4%
48.6%
53.0%
53.5%
53.9%
57.2%
57.7%
63.9%
64.7%
68.0%
68.5%
73.0%
75.7%
0% 20% 40% 60% 80% 100%
Alcohol Dependence
Hip Fracture
Ulcers
Urinary Tract Infection
Headache
Diabetes Mellitus
Hyperlipidemia
Benign Prostatic Hyperplasia
Asthma
Colorectal Cancer
Orthopedic Conditions
Depression
Congestive Heart Failure
Hypertension
Coronary Artery Disease
Low Back Pain
Prenatal Care
Breast Cancer
Percentage of Recommended Care Received
Nationwide, on average adults receive recommended care less than half the time.
Percentage of Adults Receiving Recommended Care, by Type
54.9% = Overall care 54.9% = Preventive care 53.5% = Acute care 56.1% = Chronic care
Source: McGlynn EA, et al., “The Quality of Health Care Delivered to Adults in the United States,” New England Journal of Medicine, Vol. 348, No. 26, June 26, 2003, pp. 2635-2645
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Higher spending doesn’t necessarily mean higher quality
California
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Premium and out-of-pocket expenses add up for consumers
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Health care expenses represent a substantial share of income
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Some policy approaches and ideas
Broad coverage expansion Employers required to provide coverage (“pay or play”) Individuals mandated to buy, insurers required to sell Single payer (all participate, broad tax-based financing)
Other proposals Reduce insurance and/or employer regulation Make consumers more aware of prices Reduce health care provider administrative burden Use health information technology to better manage care Change provider payments to reward “performance”
rather than volume Directly regulate new technology, and/or prices And on, and on…
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Many groups have a stake in the health reform debate
Hospitals, doctors, and other health care providers Employers Labor unions Insurance companies Government agencies: federal, state, local Consumer advocates Citizens
It’s much easier to agree that current system needs reform, than to agree on who should pay more or
be obligated to behave differently to change it.
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Health Reform: Key Issues and Challenges
Coverage expansion addresses one aspect of larger set of problems
Who should pay? Who should be subject to mandates or other new requirements?
How should “affordability” be defined for: Employers Employees/ Individuals Government
How should “quality” be defined and monitored? How can costs be contained and quality improved,
now and in future?
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What’s next?