on Health Care and Women in the US

• sam.baker@sc.edu

• 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Source: Himmelstein & Woolhandler - Unpublished analysis of NCHS data, Health Affairs 1999;18(2):176* Includes VA, NIH, subsidy for public hospitals, worker's comp, health departments etc.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