The United States Health Care System Compared to Others

1
The United States Health Care SystemCompared
to Others

• April 2006

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• The US health care system is different from those
  in all other industrialized nations
• No universal coverage
• High costs
• Many uninsured
• Patchwork delivery system

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• Why is our system so different?
• How are we different?
• Who is covered?
• Who isnt covered?
• Who pays?
• How is health care delivery organized?

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Why are we so different?
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Cultural context

• Independence/autonomy is valued.
• You get what you earn.
• Government role/ interference is questioned.
• Competition for profit brings better
  products/services.
• Technology is valued.

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The culture of health care in US vs. in Western
Europe

• Health care as a market commodity vs. health care
  as a basic human right
• Disparaging view of socialized health care vs.
  government has a responsibility to provide health
  care
• Reliance on technology vs. less reliance on
  technology.
• Litigious vs. non-litigious

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The US spends more of GNP.
GNP
Figures are from 2000. Source Anderson GF, et.
al., Multinational Comparisons of Health Systems
Data, 2002. The Commonwealth Fund, October 2002.
www.cmwf.org.
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And health indices are worse

• US is ranked 22nd in life expectancy for both men
  and women
• US ranked 28th in infant mortality rates

Life expectancy rates are from 2001. Source EBRI
Issue Brief No. 275, November 2004.
www.ebri.org. Infant mortality rates are from
1998. Source March of Dimes, http//www.marchofdi
mes.com/files/international_rankings_1998.pdf.
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How would you describe our health care system?

• Who is covered?
• Who isnt covered?
• Who pays for health care?
• How is health care delivery organized?
• And how are we different from other
  industrialized nations?

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Percentage of population with health insurance,
2000
Source Anderson GF, et. al. Multinational
Comparisons of Health Systems Data, 2002. The
Commonwealth Fund, October 2002.
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Who is covered?

• 84 of Americans have some health insurance

Source http//usgovinfo.about.com/od/censusandst
atistics/a/censusbadnews.htm
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Who is covered in the US?

• Workersbut not all
• Retireesbut not all
• People over 65
• The very poorif in certain categories
• Low income children
• Military and veterans
• Those who pay for their own health insurance

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In presentation by Davis K, U.S. Health Care
Highly Valued but Overdue for Reform. The
Commonwealth Fund, March 2004.
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Who is not covered?

• 39.6 million Americans had no health insurance in
  2000
• 45.5 million had no insurance in 2005
• Source Hoffman C, et. al. Health Insurance
  Coverage in America 2004 Update. Kaiser
  Commission on Medicaid and the Uninsured,
  November 2005.

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Most uninsured are low income
Over 300
Less than 100
200 - 300
100 - 199
Percent of Poverty Level
Source Kaiser Commission on Medicaid and the
Unisured. The Uninsured A Primer. December
2003.,
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Who are the uninsured?

• Over 80 of the uninsured are from working
  families
• 70 of the uninsured have at least one
• full-time worker in the family

Source Hoffman C, et.al.. Health Insurance
Coverage in America 2003 Data Update. Kaiser
Commission on Medicaid and the Uninsured,
December 2004..
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Why arent workers covered?
Source Colins S, et.al. On the Edge Low Wage
Workers and Their Health Insurance Coverage. The
Commonwealth Fund. March 2002.
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Uninsured rates of workers by income
Source Collins S, et. al. On the Edge Low-Wage
Workers and Their Health Insurance Coverage. The
Commonwealth Fund, March 2003.
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The United States is different
Percentage of Population with Health Insurance in
2000
Source Anderson GF, et. al. Multinational
Comparisons of Health Systems Data, 2002. The
Commonwealth Fund, October 2002.
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In addition..

• 16 million Americans are underinsured

Source Schoen C, et.al. Insured But Not
Protected How Many Adults Are Underinsured,
Health Affairs Web Exclusive, June 14, 2005
W5-289W5-302
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Percent with health insurance through public
programs, 2000
Source Anderson GF, et. al. Multinational
Comparisons of Health Systems Data, 2002. The
Commonwealth Fund, October 2002.
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Most elderly are covered in US

• 99 were covered in 2001
• 96 by Medicare

Source Employee Benefits Research Institute,
Health Insurance and the Elderly, August 2003.
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Health insurance of nonelderly, 2003
Source Hoffman C, et. al. Health Insurance
Coverage in America 2003 Update. Kaiser
Commission on Medicaid and the Uninsured,
November 2004.
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Who pays for health insurance?

• Employers
• Employees
• Retirees
• Government
• Medicare
• Medicaid
• SCHIP
• Individuals

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Who pays for health care?

• Out-of-pocket 15
• Private insurance 34
• Employer
• Individuals
• Government 45
• Medicare 17
• Medicaid/SCHIP 16
• Other public 12
• Other private 6
• Source California Health Care Foundation and
  Wilson K. Health Care Costs 101. October 2003.

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Per capita health spending, 2000
Information from 2000.
Source Anderson GF, et. al. Multinational
Comparisons of Health Systems Data, 2002. The
Commonwealth Fund, October 2002.
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Out-of-pocket spending per capita
Information from 2000.
Source Anderson GF, et. al. Multinational
Comparisons of Health Systems Data, 2002. The
Commonwealth Fund, October 2002.
28
Public vs. Private Health Spending, 2000
Source Anderson GF, et. al. Multinational
Comparisons of Health Systems Data, 2002. The
Commonwealth Fund, October 2002.
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How is the US delivery system organized?

• Its not

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How is our health care system organized?

• Private
• Independent MDs, small groups and large groups
• HMOs, PPOs, POSeach including different networks
  of MDs, hospitals and other providers
• Hospitals
• Pharmacies
• Home health agencies
• Etc, etc, etc

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How is our health care system organized?

• Public
• Free-standing community clinics
• Public health clinics
• Public hospitals
• Veterans hospitals and clinics

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What is happening in our health care system?

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Skyrocketing Health Care Costs

Projected. Source California Health Care
Foundation, Health Care Costs 101, 2004.
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Health insurance premium increases
Source California Health Care Foundation.
Health Care Costs 101, October 2004.
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Coverage is eroding

• Costs are being shifted to employees
• Higher premiums
• Higher deductibles
• Higher copays
• Benefits are being reduced
• Employers are dropping health insurance coverage
  altogether

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Numbers of uninsured rising
1
Source Kaiser Commission on Medicaid and the
Uninsured. Health Insurance Coverage in America,
2004 Data Update. November 2005.
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Safety net still struggles

• Clinics have closed
• LA clinics
• Clinics in Alameda county
• 34 States have reduced eligibility and/or
  benefits for Medicaid
• More budget cuts threatened

Source Los Angeles Times, June 24, 2003.
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Loss of confidence in US health care system

• 60 rank American health care system poor or
  fair
• Only 4 rank it excellent

Source EBRI Issue Brief No. 275. November 2004.
www.ebri.org.
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Growing concern about health care

• 22 of Americans see health care as the most
  important issue in the US today
• Health care was the top issue of concern to
  Americans in a 2004 survey

Source EBRI Issue Brief No. 275. November 2004.
www.ebri.org.
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Support for strategies to expand health care
coverage
Use taxes to fund single payor system
Expand state govt. programs to low-income
Tax credits to businesses to help cover employees
Mandate businesses to cover employees
Tax credits to help people buy health insurance
Expand Medicare to uninsured under 65
Source Kaiser Commission on Medicaid and the
Uninsured. The Uninsured A Primer. December
2003.
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• Can we promote change in our health care system?
• What are the obstacles?
• How can we overcome them?