HEALTH CARE POLICY Introduction Why health care policy

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HEALTH CARE POLICY

HEALTH CARE POLICY

Introduction • Why health care policy matters • The problem in (sort of) 3

Introduction • Why health care policy matters • The problem in (sort of) 3 charts

Health in America • US vs. the world • Emphasis on elderly • Health

Health in America • US vs. the world • Emphasis on elderly • Health care vs. health

The U. S. Health Care System • Complexity of system

The U. S. Health Care System • Complexity of system

The U. S. Health Care System • Fee for Service • Managed Care •

The U. S. Health Care System • Fee for Service • Managed Care • Government subsidized care

Problems with the U. S. System: Cost • High relative cost

Problems with the U. S. System: Cost • High relative cost

Problems with the U. S. System: Cost • Fee-for-service system • Technology • Market

Problems with the U. S. System: Cost • Fee-for-service system • Technology • Market Failure • Aging public • Medical culture • Prescription Drugs • Administrative costs • It’s the prices, stupid • What it is not

Retail Price Indexes for Basket of In-Patent Pharmaceuticals, 2010 21 US is set at

Retail Price Indexes for Basket of In-Patent Pharmaceuticals, 2010 21 US is set at 100 Price level Note: Calculations weighted relative to U. S. consumption patterns. U. S. retail prices were discounted from manufacturer prices according to the rebates obtained by the Medicaid program. Source: P. Kanavos, A. Ferrario, S. Vandoros et al. , "Higher U. S. Branded Drug Prices and Spending Compared to Other Countries May Stem Partly from Quick Uptake of New Drugs, " Health Affairs, April 2013 32(4): 753– 61. THE COMMONWEALTH FUND

Diagnostic Imaging Prices, 2013 Dollars ($US) MRI Dollars ($US) Notes: US refers to the

Diagnostic Imaging Prices, 2013 Dollars ($US) MRI Dollars ($US) Notes: US refers to the commercial average. MRI refers to magnetic resonance imaging; CT refers to computed tomography. Source: International Federation of Health Plans, 2013 Comparative Price Report. CT Scan (abdomen) 22

Total Hospital and Physician Costs, 2013 Dollars ($US) Appendectomy Bypass Surgery Dollars ($US) Notes:

Total Hospital and Physician Costs, 2013 Dollars ($US) Appendectomy Bypass Surgery Dollars ($US) Notes: US refers to the commercial average. Appendectomy prices reflect a blend of inpatient and outpatient prices based on relative utilization in each setting. Source: International Federation of Health Plans, 2013 Comparative Price Report. 23

Spending on Health Insurance Administration per Capita, 2012 Adjusted for Differences in Cost of

Spending on Health Insurance Administration per Capita, 2012 Adjusted for Differences in Cost of Living Dollars ($US) * 2011. Source: OECD Health Data 2014.

Spending per Hospital Discharge, 2012 Adjusted for Differences in Cost of Living Dollars ($US)

Spending per Hospital Discharge, 2012 Adjusted for Differences in Cost of Living Dollars ($US) * 2011. ** 2010. Source: OECD Health Data 2014. 25

Spending per Hospital Discharge, 2012 Adjusted for Differences in Cost of Living Dollars ($US)

Spending per Hospital Discharge, 2012 Adjusted for Differences in Cost of Living Dollars ($US) * 2011. ** 2010. Source: OECD Health Data 2014. 26

Problems with the U. S. System: Access • Inadequate Access • Why so many

Problems with the U. S. System: Access • Inadequate Access • Why so many uninsured? • Maldistribution of resources • Employer-based issues • Rationing

Rationing the wait

Rationing the wait

Problems with the U. S. System: Quality • Quality in cross-national perspective

Problems with the U. S. System: Quality • Quality in cross-national perspective

Problems with the U. S. System: Quality • Lack of Access • Focus on

Problems with the U. S. System: Quality • Lack of Access • Focus on sickness instead of health • Overspecialization

Contemporary Policy • Medicare • Medicaid • ACA

Contemporary Policy • Medicare • Medicaid • ACA

Affordable Care Act/ “Obama. Care” • Goals • Basics/Three-legged stool • What it’s not

Affordable Care Act/ “Obama. Care” • Goals • Basics/Three-legged stool • What it’s not • Early Assessment • “Repeal and Replace” and ACA under President Trump

Further reform? • The long-term cost problem • Lessons from abroad • Policy Options

Further reform? • The long-term cost problem • Lessons from abroad • Policy Options • Single-payer • “Medicare for all”? • “Gradual” single payer/Other public options • Employer-based reforms • Expanded individual market reforms • So, what happens?

Reforms/International Lessons • Single Payer Plan • Employer Mandates • Socialized Medicine • Individual

Reforms/International Lessons • Single Payer Plan • Employer Mandates • Socialized Medicine • Individual Mandates • Future of Health Care Reform?

Health Health Health Health Health Health Health HealthHealth Health Health Health Health Health Health Health
ECH Health Care Home Why is Health CareECH Health Care Home Why is Health Care
Health Measurement Why care about health Health affectsHealth Measurement Why care about health Health affects
Why study policy and policy processes Why studyWhy study policy and policy processes Why study
PRIMARY HEALTH CARE PRIMARY HEALTH CARE Primary HealthPRIMARY HEALTH CARE PRIMARY HEALTH CARE Primary Health
Getting Dirty with SOILS Why Care Why CareGetting Dirty with SOILS Why Care Why Care
Getting Dirty with SOILS Why Care Why CareGetting Dirty with SOILS Why Care Why Care
Lecture Outline Canadian Health Care Introduction health careLecture Outline Canadian Health Care Introduction health care
Health Care Reform SF 183 Introduction Health CareHealth Care Reform SF 183 Introduction Health Care
HEALTH CARE IN PRISON 1 INTRODUCTION Health careHEALTH CARE IN PRISON 1 INTRODUCTION Health care
Health Care Reform 101 Introduction To health CareHealth Care Reform 101 Introduction To health Care
INTRODUCTION HEALTH CARE FINANCE HEALTH CARE IS AINTRODUCTION HEALTH CARE FINANCE HEALTH CARE IS A
Forensic Reports Introduction Introduction Introduction Introduction Introduction IntroductionForensic Reports Introduction Introduction Introduction Introduction Introduction Introduction
Basic Care Wound Care Diabetic Care Incontinence CareBasic Care Wound Care Diabetic Care Incontinence Care
Basic Care Wound Care Diabetic Care Incontinence CareBasic Care Wound Care Diabetic Care Incontinence Care
Basic Care Wound Care Diabetic Care Incontinence CareBasic Care Wound Care Diabetic Care Incontinence Care
MODULE V HEALTH CARE POLICY Why Not TheMODULE V HEALTH CARE POLICY Why Not The
Chapter 10 Health Care Policy Issues Policy DefinedChapter 10 Health Care Policy Issues Policy Defined
Health Care Policy National Security Policy The BackstoryHealth Care Policy National Security Policy The Backstory
Pastoral Care An Introduction Why is Pastoral CarePastoral Care An Introduction Why is Pastoral Care
Pastoral Care An Introduction Why is Pastoral CarePastoral Care An Introduction Why is Pastoral Care
Longterm Care Home Health Care and Informal CareLongterm Care Home Health Care and Informal Care
Health Care Reform Chronic Care Management Care TransitionsHealth Care Reform Chronic Care Management Care Transitions
Care Coordination Integrated Health Care Texas Enhanced CareCare Coordination Integrated Health Care Texas Enhanced Care