Economics Perspective

1
Economics Perspective
on Health Care and Women in the US

• sam.baker_at_sc.edu
• www.pnhp.org

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Private market
for health services and health insurance
with an overlay of government spending
3
Who Pays for Healthcare?
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
Source Himmelstein Woolhandler - Unpublished
analysis of NCHS data, Health Affairs
199918(2)176 Includes VA, NIH, subsidy for
public hospitals, worker's comp, health
departments etc.
4
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 340109 Health Aff
2000 19(3)150
5
Out-of-pocket payments, US and world
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Why Women Delay Prenatal CareWhen They Know They
Are Pregnant
Note 11.1 of pregnant women failed to get
timely prenatal care despite knowing they
were pregnant
Source MMWR 5/12/2000 49393
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Infant Mortality international
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Infant Deaths by Income, Canada 1996Even the
Poor Do Better than U.S. Average
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Maternal mortality
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Life Expectancy For Women, 1997
Source OECD, 1999 NCHS
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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
12
Americans Lead the World in Hours Worked
Source International Labor Organization, 1999
13
Medical redlining
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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
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Uninsured women with breast cancer, compared with
the insured

• Have a 49 higher adjusted risk of death
• Are 1.4 x more likely to be diagnosed with breast
  cancer at a late stage

16
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

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Uninsured women aged 50-64, compared with the
insured, are

• 2.1 x less likely to have had a recent
  mammogram
• 1.9 x less likely to have had a recent Pap
  test
• 2.1 x less likely to have had a recent
  clinical breast examination

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Uninsured women aged 40-49, compared with the
insured, are

• 1.5 x less likely to have had a recent
  mammogram
• 1.9 x less likely to have had a recent Pap
  test
• 1.9 x less likely to have had a recent
  clinical breast examination

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Uninsured pregnant women, compared with the
insured

• Have a 31 higher likelihood of an adverse
  hospital outcome

20
Federal Tax Subsidies forPrivate Health
Spending, 1998
Note Total federal tax subsidy 111.2
billionSource Health Affairs 1999 18(2)176
21
Regressive US financing
Who Pays For Health Care? Regressive U.S. Health
Financing
Source Oxford Rev Econ Pol 19895(1)89
22
Progressive financing in Canada
(Province Of Alberta)
Source Premier's Common Future Of Health,
Excludes Out-of-Pocket Costs
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Administrative Cost
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Number of Insurance Products
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Private insurers High Overhead
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Milliman RobertsonPediatric Length of Stay
Guidelines

• 1 Day for Diabetic Coma
• 2 Days for Osteomyelitis
• 3 Days for Bacterial Meningitis
• They're outrageous. Theyre dangerous. Kids
  could die because of these guidelines.
• Thomas Cleary, M.D. Prof. of Pediatrics, U.
  Texas, Houston
• Listed as "Contributing Author" in MR manual

Source Modern Healthcare May 8, 200034
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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
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Fraud
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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.

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We Have What it Takes

• Excellent hospitals, empty beds
• Enough well-trained professionals
• Superb research
• Current spending is sufficient

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What We Need

• To lead our leaders