Healthcare Delivery Bibliography Economics - Harvard Kennedy
The Economics of Health Care Delivery and Reform
Transcript of The Economics of Health Care Delivery and Reform
![Page 1: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/1.jpg)
The Economics of Health Care Delivery and Reform
Sanjay Yadla, MDDepartment of Neurological SurgeryGrand RoundsOctober 30, 2009
![Page 2: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/2.jpg)
Economics of Health Care in the U.S.
OverviewWhat are the problems?What are the proposed solutions?Health Care ReformWhere should neurosurgeons stand?
![Page 3: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/3.jpg)
Health Care in the U.S.
Primarily owned and operated by the private sectorHealth insurance is primarily provided by the private sector15% of the population is completely uninsured
![Page 4: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/4.jpg)
Health Care in the U.S.
Access to Care is UnequalPoor Access is Linked to Poor QualityCare Delivery is InefficientA fragmented Health Insurance SystemInefficient Financing for Uninsured and UnderinsuredLack of positive incentives in benefit design and provider reimbursement
![Page 5: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/5.jpg)
Health Insurance Status of Individuals <65 years, 2007
![Page 6: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/6.jpg)
Percent of Americans Uninsured by Age
![Page 7: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/7.jpg)
% of Uninsured is getting Worse (20% of those <65 years)
![Page 8: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/8.jpg)
Jefferson Health System
4.8 Billion in Total Assets as of June ’08$614 million endowment (Villanova $330M, UPenn $5.3B, Harvard $26B)Medicare - 28.1% of net patient revenueIndependence Blue Cross – 27.3%, the largest commercial insurance carrier
![Page 9: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/9.jpg)
Jefferson Health System
Founded in 1995: Main Line Health System and TJUH IncNonprofit entity under one corporate parentAlbert Einstein Healthcare Network, Frankford Health Care System, Magee Rehabilitation Hospital
![Page 10: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/10.jpg)
Joseph T.Sebastianelli, President and CEO of JHS
![Page 11: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/11.jpg)
Most Profitable Medical Equipment Companies
ProductsNet Income ’07 ($millions)
Company
LensCrafters and Pearle Vision,
Oakley, Ray-Ban
$775Luxottica Group
needles, syringes, surgical blades &
scalpels
$856Becton, Dickinson and Co.
Orthopedic Implants $987Stryker
ADVATE rAHF-PFM $1,707Baxter Int’l
world’s leading supplier of PPMs
$2,231Medtronic
![Page 12: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/12.jpg)
Most Profitable Biotechnology and Drug Companies ‘07
Lipitor, Norvasc$8,209Pfizer
ProductsNet Income ’07 ($millions)
Company
Diovan, Lotrel$6,516Novartis AG
Lovenox, Plavix, Ambien
$8,288Sanofi-Aventis
Advair, Lamictal, Vaccines
$10,384GlaxoSmithKline
Remicade, Topamax,
Procrit, DePuy, Cordis
$10,576Johnson & Johnson
![Page 13: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/13.jpg)
Where does Pharmaceutical Revenue Go?
![Page 14: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/14.jpg)
Are We Getting Our Money’s Worth?
USA is 42nd in the world in life expectancyWHO: US Health Care system 37th in overall performanceWHO: US Health Care system 72nd in overall level of health (of 191)
![Page 15: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/15.jpg)
National Health Expenditures as a Share of GDP, 1980-2040
![Page 16: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/16.jpg)
Health Care Spending as a % of GDP
![Page 17: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/17.jpg)
Out of Pocket Spending
![Page 18: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/18.jpg)
Health Insurance Premiums vsOther Economic Indicators
![Page 19: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/19.jpg)
Total Spending on Medicare/ Medicaid as a Share of GDP
![Page 20: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/20.jpg)
Are We Getting Our Money’s Worth?
![Page 21: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/21.jpg)
Are We Getting Our Money’s Worth?
![Page 22: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/22.jpg)
On the other hand…
US is the leader in medical innovation by revenue, # of new drugs and devices introducedIn 2006, 82% of world R&D spending in biotechnologyWhat does GDP vs Life Expectancy mean?
![Page 23: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/23.jpg)
![Page 24: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/24.jpg)
Life Expectancy
Health care and institutionsAlso reflects personal behaviors:
DietExerciseSmokingCompliance with medical protocols
![Page 25: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/25.jpg)
Low life expectancy primarily due to high mortality rates above age 50Cancer and CV disease responsible for 61% of deaths at age 45+Breast and Prostate Cancer - screening available, behavioral factors not dominant Outcome: death avoidance
![Page 26: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/26.jpg)
![Page 27: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/27.jpg)
![Page 28: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/28.jpg)
Health Care in the U.S.
Primarily owned and operated by the private sectorHealth insurance is primarily provided by the private sector15% of the population incompletely uninsured
![Page 29: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/29.jpg)
Administration Costs
![Page 30: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/30.jpg)
Patients Needing Costly Services
10% of patients account for 70% of health care expendituresMultiple chronic conditions, many medications, frequent hospitalizationsMedicare beneficiaries with >5 chronic conditions = 76% of expenditures17x spending for those with no chronic conditions
![Page 31: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/31.jpg)
Follow the Money — Controlling Expenditures by Improving Care for Patients Needing Costly ServicesPosted by NEJM • September 30th, 2009
Thomas Bodenheimer, M.D., M.P.H., and Rachel Berry-Millett, B.A.
![Page 32: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/32.jpg)
![Page 33: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/33.jpg)
![Page 34: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/34.jpg)
![Page 35: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/35.jpg)
Cost effectiveness of preventive medicine50 year-old female smoker, total cholesterol >240 (“high”), HDL<40 (“low”), untreated moderate hypertension11 percent chance of MI over 10 yrs$240,000 for every year of life saved (QALY)
![Page 36: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/36.jpg)
![Page 37: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/37.jpg)
All patients diagnosed with appendicitis from 2001 to 2005CIHI database and US NISPatients categorized by age, gender, insurance status, race, and socioeconomic statusOdds of perforation determined
![Page 38: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/38.jpg)
Appendicitis:Consistent natural historySingle definitive treatment (appendectomy)Distinct negative outcome (perforation)No known biological predispositionStrong association between treatment delay and adverse outcome (perforation)
![Page 39: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/39.jpg)
![Page 40: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/40.jpg)
![Page 41: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/41.jpg)
Access Problems because of Costs, 2004
![Page 42: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/42.jpg)
Health Care in the U.S.
Access to Care is UnequalPoor Access is Linked to Poor QualityCare Delivery is InefficientA fragmented Health Insurance SystemInefficient Financing for Uninsured and UnderinsuredLack of positive incentives in benefit design and provider reimbursement
![Page 43: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/43.jpg)
Health Care Reform
![Page 44: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/44.jpg)
Health Care Reform Principles
Improved AccessImproved QualityGreater EquityGreater EfficiencyControl Costs
![Page 45: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/45.jpg)
From Health Care Bill to Law
www.cbs.com
![Page 46: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/46.jpg)
Senate Finance Committee “Baucus” Bill
America’s Healthy Future Act of ’09Does not include “public option”Does specify creation of healthcare cooperatives (non-profit, member-controlled)Creates individual mandate:
Penalty of up to $950/person, $3800/familySubsidies for low income families/individuals
![Page 47: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/47.jpg)
Senate Finance Committee “Baucus” Bill
Individuals can buy insurance from an exchange in their statePremiums capped at 13% of incomeBasic services: hospitalization, maternity, newborn, chemotx, pediatric
![Page 48: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/48.jpg)
Senate Finance Committee “Baucus” Bill
Forbids insurance restriction based on “pre-existing conditions”Tobacco use, age, family size, geography can influence premiumsExcise tax on “Cadillac” health plans$829 Billion over the next ten yearsBy 2019, <65 yrs, 83%->94% covered
![Page 49: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/49.jpg)
AANS/CNS Response
Tippett (AANS)/Adelson (CNS)press release September 22‘seriously misses the mark’‘express disappointment in the process’
![Page 50: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/50.jpg)
AANS/CNS Response
No protections to ensure patient choiceNo options for medical liability reformThe alternative co-op proposal may lead to a government-run planIgnores looming workforce shortages
![Page 51: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/51.jpg)
Top Ten Baucus Campaign Contributors from 2005
![Page 52: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/52.jpg)
Courtesy of the Philadelphia Historical Digital Image Library
![Page 53: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/53.jpg)
For every thousand hacking at the leaves of evil, there is one striking at the root. – Henry David Thoreau
![Page 54: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/54.jpg)
![Page 55: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/55.jpg)
Innovations in Care: Care Management
Activities designed to assist patients and their support systems Manage medical conditions and related psychosocial problems more effectivelyEnhance the coordination of care, eliminate the duplication of services, and reducing the need for expensive medical services.Generally provided by a registered-nurse care manager, often working with a multidisciplinary team.
![Page 56: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/56.jpg)
Care Management
Working with the patient,family, and the primary care physician to prepare a care plan Teaching patients and families about diseases and medicationsCoaching patients and families on how to respond to worsening symptoms in order to avoid ED visits and hospital admissions Tracking patients’ status over time Revising care plans as needed
![Page 57: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/57.jpg)
![Page 58: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/58.jpg)
![Page 59: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/59.jpg)
![Page 60: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/60.jpg)
Cost-Effectiveness of Certain Preventive Measures
![Page 61: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/61.jpg)
![Page 62: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/62.jpg)
8%100%606.6Total
19% 3% 15.4 Canada
13% 3% 20.9 Middle East, Africa
21% 5% 29.4 Latin Amer
14% 7% 43.1 Asia Pacific
-3% 10% 57.9 Japan
7%3%19.4Italy
3%3%20.0UK
3%5%30.7Germany
4%5%32.6France
6% 28% 171.7 Europe
9% 44% 268.3 USA
Growthvs
2005 % ofTotal
Value($Bn)
Pharmaceuticals World Market Share by Region (2006)
![Page 63: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/63.jpg)
![Page 64: The Economics of Health Care Delivery and Reform](https://reader031.fdocuments.net/reader031/viewer/2022013000/61c99be26507181a3a05cb70/html5/thumbnails/64.jpg)
Public Health Care
MedicareMedicaidMilitary Health System / TRICAREState Children’s Health Insurance ProgramVeterans Health AdministrationIndian Health ServiceFederal Employees Health Benefits