Rising Health Care Costs, Rising Health Care Costs, Prevention - - PowerPoint PPT Presentation
Rising Health Care Costs, Rising Health Care Costs, Prevention & Primary Care, and Prevention & Primary Care, and Personal Responsibility Personal Responsibility Marcia Nielsen, Ph.D., MPH Marcia Nielsen, Ph.D., MPH Executive
Marcia Nielsen, Ph.D., MPH Marcia Nielsen, Ph.D., MPH Executive Director Executive Director July Advisory Council Meetings July Advisory Council Meetings
Dr Fineberg, President of IOM, National Governor’s Association Meeting, July 2007
Dr Fineberg, President of IOM, National Governor’s Association Meeting, July 2007
Secretary Bremby, KHPA Board Retreat, 2007
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% U.S. Population Health Expenditures
Health Care Costs Concentrated in Sick Few — Sickest 10 Percent Account for 64 Percent of Expenses
1% 5% 10% 49% 64% 24%
Source: The Commonwealth Fund. Data from S. H. Zuvekas and J. W. Cohen, “Prescription Drugs and the Changing Concentration of Health Care Expenditures,” Health Affairs, Jan./Feb. 2007 26(1):249–57.
50% 97% $36,280 $12,046 $6,992 $715 Distribution of health expenditures for the U.S. population, by magnitude of expenditure, 2003
Expenditure threshold (2003 dollars)
Health Expenditure Grow th 2000–2005 for Selected Categories of Expenditures
12.0 8.6 8.0 7.9 6.1 10.7
5 10 15 20
Total Hospital care Physician & clinical services Nursing home & home health Prescription drugs
net cost of private health insurance
Average annual percent grow th in health expenditures, 2000–2005
Source: A. Catlin et al., “National Health Spending in 2005: The Slowdown Continues,” Health Affairs, Jan./Feb. 2007 26(1):142–53.
Health Care Expenditure per Capita by Source of Funding in 2004
$803 $472 $313 $582 $396 $389 $359 $2,572 $483 $342 $354 $2727 $2,210 $2,475 $1,894 $2,350 $1,940 $2,176 $1,917 $1,832 $1,611 $239 $238 $148 $906 $444 $113 $28 $370
$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000
United States Canada France Netherlands Germany Australia United Kingdom OECD Median Japan New Zealand
Private Spending Out-of-Pocket Spending Public Spending
a b
a2003 b2002 (Out-of-Pocket)
a a
Source: The Commonwealth Fund, calculated from OECD Health Data 2006.
Adjusted for Differences in Cost of Living
Environment 22% How We Live - Behavior 51% Medical Care 10% Genetic Make-Up 17%
Source: USDHEW, PHS, CDC. “Ten Leading Causes of Death in US 1975.” Atlanta, GA, Bureau of State Services, Health Analysis & Planning for Preventive Services, p 35, 1978
* National Center for Health Statistics. Mortality Report. Hyattsville, MD: US
Department of Health and Human Services; 2002
† Adapted from McGinnis Foege, updated by Mokdad et. al.
Actual Causes of Death †
Tobacco Poor diet/ lack of exercise Alcohol I nfectious agents Pollutants/ toxins Firearm s Sexual behavior Motor vehicles I llicit drug use
Causes of Death United States, 2 0 0 0
Leading Causes of Death*
Percentage ( of all deaths)
Heart Disease Cancer Chronic low er respiratory disease Unintentional I njuries Pneum onia/ influenza Diabetes Alzheim er’s disease Kidney Disease Stroke
Percentage ( of all deaths)
5 10 15 20 25 30 35 5 10 15 20
1 9 9 6 1 9 9 1 2 0 0 3
Obesity Trends* Am ong U.S. Adults BRFSS, 1 9 9 1 , 1 9 9 6 , 2 0 0 3
( * BMI ≥3 0 , or about 3 0 lbs overw eight for 5 ’4 ” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
<4% 4–6% >6%
YRBS National Surveys, 1991–2001 Centers for Disease Control & Prevention
Environment
Family School Worksite Community
Medical System
Information Systems Decision Support Delivery System Design Self Management Support Patient Self-Management
Source: The Commonwealth Fund 2006 Quality of Care Survey
Adults w ith a Medical Home Are More Likely to Report Checking Their Blood Pressure Regularly and Keeping It in Control
29 42 25 15 10 17 56 48 58
25 50 75 100
Total Medical home Regular source of care, not a medical home
Does not check BP Checks BP, not controlled Checks BP, controlled
Percent of adults 18–64 w ith high blood pressure
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone
running on time.
Source: The Commonwealth Fund 2006 Quality of Care Survey
55 74 52* 38*
25 50 75 100
Total Medical home Regular source of care, not a medical home No regular source of care/ER
Source: Commonwealth Fund 2006 Health Care Quality Survey.
The Majority of Adults w ith a Medical Home Alw ays Get the Care They Need
Percent of adults 18–64 reporting alw ays getting care they need w hen they need it
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running
* Compared with medical home, differences remain statistically significant after adjusting for income or insurance.
Source: The Commonwealth Fund 2006 Quality of Care Survey
80 65 73 69 39* 34*
25 50 75 100
Insured all year Any time uninsured
Medical home Regular source of care, not a medical home No regular source of care/ER
Percent of obese or overw eight adults 18–64 w ho w ere counseled on diet and exercise by doctor
Adults w ith a Medical Home Have Higher Rates
Source: Commonwealth Fund 2006 Health Care Quality Survey.
Note: Medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running
* Compared with medical home, differences are statistically significant.
Follow ing Treatment Regimens for Chronic Diseases
Percent of privately insured adults 21–64 w ith chronic conditions w ho strongly/somew hat agree that they follow their treatment regimens very carefully 67 64 62 59 88 75 84 63 49 51 89 51 65 73 70 25 50 75 100
Allergies Arthritis Depression High Cholesterol Hypertension
Comprehensive HDHP CDHP
Comprehensive = health plan with no deductible or <$1,000 (individual), <$2,000 (family). HDHP = high-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. CDHP = consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. *Difference between HDHP/CDHP and Comprehensive is statistically significant at p ≤ 0.05 or better.
(n=89) (n=74)
Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2006.
6 9 12 15 21 26 25 50 GER NZ UK AUS CAN US 23 41 24 20 29 23 36
White Black Hispanic Above average income Below average income Insured Uninsured
International comparison United States, by race/ethnicity, income, and insurance status
Went to ER for Condition That Could Have Been Treated by Regular Doctor, Among Sicker Adults, 2005
Percent of adults who went to ER in past two years for condition that could have been treated by regular doctor if available
GER=Germany; NZ=New Zealand; UK=United Kingdom; AUS=Australia; CAN=Canada; US=United States. Data: Analysis of 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults; Schoen et al. 2005a.
EQUITY: COORDINATED AND EFFICIENT CARE
Adults Without Insurance Are Less Likely to Be Able to Manage Chronic Conditions 18 16 58 27 59 35
25 50 75
Skipped doses or did not fill prescription for chronic condition because of cost Visited ER, hospital, or both for chronic condition
Insured all year Insured now , time uninsured in past year Uninsured now
Percent of adults ages 19–64 w ith at least one chronic condition*
Source: S. R. Collins, K. Davis, M. M. Doty, J. L. Kriss, A. L. Holmgren, Gaps in Health Insurance: An All-American Problem, Findings from the Commonwealth Fund Biennial Health Insurance Survey (New York: The Commonwealth Fund, Apr. 2006).
*Hypertension, high blood pressure, or stroke; heart attack or heart disease; diabetes; asthma, emphysema, or lung disease.
Source: 2003 Kansas Behavioral Risk Factor Surveillance System. 2002 Kansas Youth Tobacco Survey. Office of Health Promotion, KDHE.
Source: 2003 Kansas Behavioral Risk Factor Surveillance System.
Overweight or obese body mass index ≥ 25.0 kg/m2 Obese body mass index ≥ 30.0 kg/m2 Source: 2003 Kansas Behavioral Risk Factor Surveillance System. Office of Health Promotion, KHDE
In 1999-
2000, 15% of 6-
19 year old children & teens were overweight. were overweight.
Over 10% of pre-
school-
aged children (ages 2 -
5) are overweight (up from 7% in 1994). (up from 7% in 1994).
Another 15% of children and teens are 15% of children and teens are considered at risk considered at risk for becoming overweight for becoming overweight
Childhood obesity has increased 36% increased 36% in the past in the past 20 years 20 years
Source: Kansas Department of Health & Environment Office of Health Promotion
th (23.3%) of adult Kansans had
Source: 2003 Kansas Behavioral Risk Factor Surveillance System.
34.8% 34.5% 33.8% 34.1% 34.5% 39.2% 37.1% 37.2% 37.9% 35.4% 37.4%
31.0% 32.0% 33.0% 34.0% 35.0% 36.0% 37.0% 38.0% 39.0% 40.0% 1 9 9 2 1 9 9 3 1 9 9 4 1 9 9 5 1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 2 1 2 2
Source: Kansas Department of Health & Environment Behavioral Risk Factor Surveillance System
0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 1 9 9 2 1 9 9 3 1 9 9 4 1 9 9 5 1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 2 1 2 2
Kansas Department of Health & Environment Behavioral Risk Factor Surveillance System
28.90% 38.30% 34.50% 30.90% 36.40% 38.30% 30.40% 26.70% 22.50%
0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00% 1992 1993 1994 1995 1996 1998 2000 2001 2002
Source: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Behavioral Risk Factor Surveillance System Trends Data: Kansas
Current Cigarette Smokers in Kansas 1992 Current Cigarette Smokers in Kansas 1992 -
2003
0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%
Percentage of Adult Population
Kansas 22.4 20.3 21.8 22.0 22.1 21.0 21.1 21.0 21.0 22.2 22.1 20.4 National 22.2 22.6 22.7 22.4 23.4 23.2 22.9 22.6 23.2 22.8 23.0 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Source: 1992-2003 Behavioral Risk Factor Surveillance System , Office of Health Promotion, Kansas Department of Health and Environment National data : 1992-2003 Behavioral Risk Factor Surveillance System , Centers for Disease Control and Prevention.
Prevalence of cigarette use among adults in Kansas has remained relatively unchanged. This trend is similar to the trend in the United States. Prevalence of cigarette us in Kansas is highest among individuals of low education (36.4% for less than high school) and low income (28.6% for < $15,000 annual household income)
adult prevalence rate. Youth rates are used to measure youth access and initiation.
remained consistently in the 40-50% range since 2000. Cessation attempts are used to gauge community norm changes as well as short/intermediate term
Source: 2000-2003 Behavioral Risk Factor Surveillance System , Office of Health Promotion, Kansas Department of Health and Environment 2000 and 2002 Kansas Youth Tobacco Survey, Office of Health Promotion, Kansas Department of Health of Environment
Getti Getting Value for Money: Healt ng Value for Money: Health System Transformation System Transformation Getti Getting Value for Money: Healt ng Value for Money: Health System Transformation System Transformation
Transparency; public information on clinical quality, patient -
centered care, and efficiency by provider; insurance premiums, medical outlays, and efficiency by provider; insurance premiums, medical outlays, and and provider payment rates provider payment rates
Payment systems that rew ard quality and efficiency; transition to population
and care episode payment system and care episode payment system
Patient -
centered medical home; Integrated delivery systems and accountable physician group practices accountable physician group practices
Adoption of health information technology; creation of state-
based health insurance exchange insurance exchange
National Institute of Clinical Excellence; invest in comparative cost cost -
effectiveness research; evidence -
based decision-
making
Investment in high performance primary care w orkforce
Health services research and technical assistance to spread best practices practices
Public -
private collaboration; national aims; uniform policies; simplification; cation; purchasing pow er purchasing pow er
Source: The Commonwealth Fund
18 16 17 49 43 5 16 10 75 85 20 40 60 80 100
Proportion of under-65 population that has no health insurance Total cost of health care as a percentage
Proportion of households spending >10% of income on OOP costs and premiums* Proportion of recommended preventive care adults receive Proportion of recommended preventive care children receive
Current Goal
Percent
Transformation Is Possible Transformation Is Possible Transformation Is Possible Transformation Is Possible
Source: Commonwealth Fund Health Care Opinion Leaders Survey, Jan. 2007.
"What you w ould see as both an achievable and a desirable goal or target for policy action w ithin the next 10 years?"
Note: Goal percentages represent median responses. * Or 5% of household income for low-income households; OOP = “out-of-pocket”.
Health Care Opinion Leaders: Health Care Opinion Leaders: View s on Controlling Rising Health Care Costs View s on Controlling Rising Health Care Costs
50% 51% 54% 54% 57% 61% 65% 66% 70% 75% Consolidate purchasing power by public, private insurers working together to moderate rising costs of Have all payers, including private insurers, Medicare, and Medicaid, adopt common payment methods or rates Establish a public/private mechanism to produce, disseminate information of effectiveness, best practices Reduce administrative costs of insurers, providers Allow Medicare to negotiate drug prices Reward providers who are more efficient and provide higher quality care Increase the use of disease and care management strategies for the chronically ill Increased and more effective use of IT Use evidence-based guidelines to determine if a test, procedure should be done Reduce inappropriate medical care “How effective do you think each of these approaches w ould be to control rising costs and improve the quality of care?” Percent saying “extremely/very effective”
Note: Based on a list of 19 options. Source: The Commonwealth Fund Health Care Opinion Leaders Survey, Jan. 2007.
Dr Fineberg, President of IOM, National Governor’s Association Meeting, July 2007