What would Single Payer Mean for NPs? N P O 3 9 TH AN N U AL E D U - PDF document

9/27/2016 What would Single Payer Mean for NPs? N P O 3 9 TH AN N U AL E D U CATI ON CON F E R E N CE N AN CY S U LLI VAN , R N , M S , F ACN M CH R I S TAN N E R , R N , P H D , AN E F R E P R E S E N TI N G N U R S E S F OR S I N GLE P AYE R ( N F S P ) A M OVEM EN T TO GAIN U N IVER S AL, COM P R EH EN S IVE, P U B LICLY F U N D ED H EALTH CAR E Overview Current payment methods and impact on: Quality, access and outcomes of care Daily practice of providers Four models of health care coverage already tested in the developed world Self pay Socialized medicine Single payer, government funded Government regulated, private insurers Proposed state & federal approaches to universal, publicly funded care: Oregon’s proposed legislation Colorado’s ballot initiative ACA public option Physicians for National Health Program Impact on care 1

Spending Spe of GDP of GD He Healt Ca Care as as % alth % D EVELOP ED W ORLD 10 15 20 0 5 EX P EN S IVE IN TH E Am erican Health Care Financing Issues with current The m ost expensive Es Eston tonia Turkey Tu ey paym ent system Mexico Mexic Lu Luxembou xembourg rg Poland Po TH E MOS T Korea Kor Czech Re Cz Repu public Ch Chile Isra Is rael el Hu Hungary Slov Slovak Republ Republic ic Sloven Slov enia ia Irela Ir eland Austra Au ralia lia Finland Fin Ic Icela eland Greece Gr eece It Italy No Norway Spain Spa United K Un ed Kingdo ngdom Sweden Sweden Ja Japa pan Po Portuga ugal New Z Ne Zeal alan and ¹ Belgium Bel ium ¹ ¹ Au Austria ria Denmark Den Switzer Switzerland Cana Ca nada Ger Germany Fr Fran ance Netherlands Ne United Sta Un ited States es 9/27/2016 2

9/27/2016 Health care costs predicted to continue rising 19% 18% Health 17% Care 16% Costs 15% As Share 14% Of 13% Gross State 12% Product 11% 10% 1991 1994 1997 2000 2003 2006 2009 2012 2015 2018 2021 2024 Health Insurers Making Record Profits as Many Postpone Care NYTim es May 13, 2011 Cigna, Hum ana CEOs earn m illions in pay jum ps http:/ / www.fiercehealthpayer.com/ story/ cigna-humana-ceos-earn-millions-pay-jumps/ 2012- 03-07 Cigna profit exceeds expectations; lower costs help Reuters, August 1, 2013 Rising adm inistrative costs 3000% Growth Since 1970 2500% 2000% 1500% 1000% 500% 0 1970 1980 1990 2000 2010 Physicians Administrators Data updated through 2013 Source: Bureau of Labor Statistics; NCHS; Himmelstein/Woolhandler analysis of CPS 3

9/27/2016 Rising Drug Prices TO K E E P I N M I N D W H E N YO U R E A D A LL TH E H YP E A B O U T R I S I N G D R U G P R I CE S : “P A TI E N TS W H O A R E TH E S I CK E S T A N D R E Q U I R E TH E M O S T E X P E N S I V E D R U G S A R E TH E M O S T V U LN E R A B LE TO S O A R I N G D R U G P R I CE S . “I T’S S O R T O F E M B E D D E D I N TH E H E A LTH CA R E S YS TE M TH A T TH E P R I CE I S N E V E R TH E P R I CE , U N LE S S YO U ’R E A CA S H - P A YI N G CU S TO M E R , ” S TA TE S TH E P R E S I D E N T O F A B U S I N E S S R E S E A R CH CO M P A N Y, “A N D I N TH A T CA S E , W E S O A K TH E P O O R . ” ( K . TH O M A S , N YT, A U G 2 4 , 2 0 16 ) Individuals and Families are bearing more of the cost of health insurance & treatment  Between 2011-1016, incomes have increased by 11% while . . .  Deductibles increased 63% on average for people who get health insurance through employers  Workers’ contributions to premiums have increased by 23% Source: KFF.org 2016 Em ployer Health Benefits Survey 4

9/27/2016 Individuals and Families are bearing more of the cost of health insurance & treatment  Average price of brand-name medicines jumped 164% from 2008-2015*  24% of Amercians find it very or somewhat difficult to afford prescription drugs** Sources:* Express Scripts 2015 Drug Trend Report, Executive Sum m ary, March 2016 **2015 Kaiser Fam ily Foundation survey Even with the Affordable Care Act . . . . The large increase in health care costs has created hardships, and sometimes disasters, for individuals and families 600 Oregonians die Due to lack of affordable health care, each year 8,000 go bankrupt 5

9/27/2016 Case Study: Lane County, Oregon  Population – 356,000  800 personal bankruptcies in 2014, with 72% related to medical debt AND 10 biggest creditors all medical businesses.  Non-profit PeaceHealth increased profits from $39.6 million in 2013 to $97.4 Million in 2014.  PeaceHealth used aggressive collection tactics against Hollie Murphie, who was so underinsured with her employee plan that she was left with thousands of dollars of medical Bills. Peace Health garnished her wages to cover cost of her surgery. The best health care system ? S H ORTER LIVES , P OORER H EALTH , LOW ER S ATIS FACTION , LES S ACCES S TO CARE Life Expectancy at Birth, Affluent Countries 85 80 75 US life expectancy lower even 70 for those with insurance! 65 60 6

9/27/2016 Years of Lost Life Before Age 50 in Men, 20 0 6-20 0 8 National Academies Press (2013) Health in International Perspective: Shorter Lives, Poorer Health Years of Lost Life Before Age 50 in Wom en, 20 0 6-20 0 8 National Academies Press (2013) Health in International Perspective: Shorter Lives, Poorer Health Infant Mortality Rates in 17 countries,20 0 5-20 0 9 National Academies Press (2013) Health in International Perspective: Shorter Lives, Poorer Health 7

9/27/2016 Poorer health, using m any indicators  The USA has the highest prevalence of diabetes in young adults age 15-44 of any developed country.  Americans under 50 have the highest incidence of heart attack, stroke, cancer, diabetes, and activity limitations in comparison with 10 other developed countries. National Academies Press (2013) Health in International Perspective: Shorter Lives, Poorer Health Access To Health Care 70% 60% 63% Americans have the most USA Uninsured problems – even those 50% Cost- with insurance 40% Related Access 37% 30% Problem USA Insured 27% 20% 22% 21% 18% 16% 15% 10% 13% 13% 10% 6% 4% 0% AUS CAN FRA GER NET NZL NOR SWE SWI UK USA USA USA All Ins Unins Did not see a doctor when sick or did not get recommended care because of cost, did not fill Rx or skipped doses because of cost Commonwealth Fund data reported in Schoen, C et al.Health Affairs 32,No.12 (2013):2205-2215 Satisfaction with health system 60% Propor ortion on saying sa 40% health hea care care system sys 20% wo works we well 0% Australia Canada France Germany Netherlands New Zealand Norway Sweden Switzerland UK USA 8

9/27/2016 What do these countries have in common?  Some form of universal, publicly funded health care Some Examples of Other Health Financing Models: Germany, Japan, Belgium & Switzerland  “The Bismarck Model”  Both health care providers and payers are private entities  Private health insurance plans, financed by employers and employees through payroll deduction  Unlike US – health plans non-profit charities that cover everyone  Physicians and many hospitals are privately owned  Tight regulation of medical services and fees  Source: Reid, T.R. (2010) The Healing of Am erica: A Global Quest for Better, Cheaper and Fairer Health Care. New York: Penguin Books 9

9/27/2016 Some Examples of Other Health Financing Models: GreatBritain, Italy, Spain & most of Scandinavia  “The Beveridge Model”  Health care is provided and financed by the government, through taxes  No medical bills – it’s a service, like fire department & police protection  Many hospitals & clinics owned by government  Providers are government employees, although there are also private doctors who collect fees from gov. Most like the VA System Source: Reid, T.R. (2010) The Healing of Am erica: A Global Quest for Better, Cheaper and Fairer Health Care. New York: Penguin Books Some Examples of Other Health Financing Models: Canada  National Health Insurance Model  Elements of both Bismarck & Beveridge Models  Providers of health care are private  Payer is government-run insurance program that every citizen pays into  Plan collects monthly premiums and pays medical bills  No need for marketing, no expensive underwiting offices to deny claims, no profit  Considerable market power to negotiate lower prices Source: Reid, T.R. (2010) The Healing of Am erica: A Global Quest for Better, Cheaper and Fairer Health Care. New York: Penguin Books Some Examples of Other Health Financing Models: Rural regions of Africa, India, China & South America  “The Out of Pocket Model”  Most medical care paid for by patient with no insurance or government plan to help  Out of pocket expenses account for 95% of health spending in Cambodia, 21% in US (in 2008)** Source: Reid, T.R. (2010) The Healing of Am erica: A Global Quest for Better, Cheaper and Fairer Health Care. New York: Penguin Books World Bank Data (2016) Out of pocket health expenditure on health. Accessd from http:/ / data.worldbank.org/ indicator/ SH.XPD.OOPC.ZS 10