The Employer-based Health Care System: Shifting Responsibilities
2007 National Health Policy ConferenceEduardo Sanchez, M.D., M.P.H.
Director, Institute for Health PolicySchool of Public Health
University of Texas Health Science Center at HoustonFebruary 12, 2007
Employer-financed Health Careand the Uninsured
– Healthcare premiums are growing more than 3 times faster than workers’ wages and 2.5 times faster than the inflation rate
– Percentage of employers providing health benefits
• 2000 69%• 2005 60%
– State of Texas employee health care costs up 53% since 2000
The Rising Spiral of Health-Care Costs
2005 Kaiser Foundation Survey
Employer-SponsoredInsurance Coverage
• 61% have insurance through their employer in the United States
• In Texas, only 53% have insurance through their employer
• 43% of companies with 50 or less employees provide insurance nationally
• In Texas, only 31% of companies with 50 or less employees provide insurance
Texas Hospital Association, April 2006
Government-SponsoredInsurance Coverage in Texas
• Medicaid
• CHIP
• County-based medical programs
• Health insurance for employees/retirees
Texas Hospital Association, April 2006
Spiral of Health Cost Increases with
High Numbers of UninsuredUninsured utilize higher
than necessary levels of care
More uninsured
More employers drop coveragebecause of high premiums
Insurance companiesRaise premiums for insured
Increased chargesto paying customers
Higheruncompensated costs
For More Information
Task Force Websitehttp://www.utsystem.edu/hea/taskforce/homepage.htm
Report Websitehttp://www.coderedtexas.org
How can the spiral be interrupted?
• Reduce the number of uninsured– Increase numbers of eligible and enrolled in
Medicaid/CHIP/state or local government programs
– Make insurance more accessible/affordable • Individually purchased• Employer provided
– Necessary but not sufficient
The Healthcare Equation is Out of Balance
Demand• Older• Heavier• More Sedentary• Un & Underinsured• Health Illiterate
Supply• Increasing Access • Increasing Workforce• System Redesign • Improving Quality of Care • Improving Technology • Improving Meds
Demand Reduction Is Imperative
Supply
• Increasing Access
• Increasing Workforce
• System Redesign
• Improving Quality of Care
• Improving Technology
• Improving Meds
Demand Reduction Is Imperative
Health PromotionHealth Promotion• Health literacy initiativesHealth literacy initiatives
• Healthier lifestylesHealthier lifestyles
• Access to care (clinical Access to care (clinical
preventive services)preventive services)
The Healthcare Equation is Out of Balance
How can the spiral be interrupted?
• Improve population health– Traditional and chronic disease-focused
public health– School-based health education and
management– Worker health promotion (worksite wellness)
How can the spiral be interrupted?
• Transform the health care delivery system– Invest in and connect to public health– Primary-care centered health system
Patient Centered Medical Home (mental/dental/medical)1. Easy access2. Continuity of care3. Comprehensive care4. Coordination of all care(Includes disease management)
TobaccoPrevention
And Cessation
ComprehensiveSchool Heath
Education
Worker and WorksiteWellness
Specialty Care
Diagnostic Testing
Hospital BasedCare
Inpatient Care
Emergency and trauma care
Primary-care Centered Health System
Public Health
Primary Care Specialty/Tertiary Care
Medical Care
Concept
= Optimal Communication (Integrated Virtual System)
Including best use of health informational technology
Two questions to ponder
• Who pays and how?– Financing
• What are we buying?– Population health