Transcript Document

What is Driving
Health Care Reform
and How to Use it
for Success
Edward O’Neil, PhD, MPA, FAAN
[email protected]
Director and Professor
The Center for Health Professions
University of California,
San Francisco
Health Care Cost and Obama Agenda
• Cost doubled as % of GDP in
thirty years
Sources of Growth in Projected Federal Spending
on Medicare and Medicaid (Percentage of GDP)
• CBO is projecting double
again to 30% by 2035.
• Increases not driven aging
population
• Costs do not appear to
contribute to quality.
• An enormous opportunity
for the nation to rebuild
health care on a more
effective and responsive
foundation.
Source: CBO Health Fact Sheet,
http://www.cbo.gov/publications/collections/health.
cfm
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Current Drivers - Demographic Aging
Source: U.S. Census Bureau
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Current Drivers - Diversity- Disparity
Life Expectancy at Birth, US
90
85
White Female
80
75
78.1
75.6
70
65
68.3
68
60
60
72.5
70.7
63.8
1970
1980
79.4
73.6
72.7
79.9
75.1
74.7
68.2
Black Female
White Male
69.7
Black Male
64.5
1990
80.6
76.5
75.7
2000
2006
2006
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Source: National Center for Health Statistics, HHS, National Vital Statistics Report, August 19, 2009http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_01.pdf
Changes in Cause of Death,
1900–1999
Source: Centers for Disease Control and Prevention. Control of infectious diseases, 1900–1999. Morbidity and Mortality Weekly Report 1999; 48:621–629.
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Growing Disease Burden
The Number of People with Chronic
Conditions is Rapidly Increasing
(millions of people by year)
180
170
160
150
140
130
120
110
100
• By 2030, 171 million
Americans, nearly half
the population, will have
one or more chronic
condition
• Medicare spending is
12% of the federal
budget and is expected
to increase 8% every
year from 2007 to 2016
1995 2000 2005 2010 2015 2020 2025 2030
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Source: Wu, Shin-Yi and Green, Anthony. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, October 2000
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Current Drivers - Epidemiology
Limitation of Activity Casused by Chronic Condition, >65
40
Percent
38
36
34
32
30
1997
1999
2000
2001
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SOURCE: Health US, 2003, USHHS, CDC,NCHCS, October 2003, 56.
Paradigms
80
70
60
Productivity
• Effective tools
• Make things work
• Provide
coherence
• Eventually, limit
what we think we
can do
• Fail
50
40
30
20
10
0
Inputs
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Current Situation- Comparative use
Bed Days Per Capita
Annual MD Consults Percapita
2
2.0
15.0
10.0
1.7
1
6.4
7.0
6.4
5.9
5.1
5.0
0.9
0.9
1.0
0.7
4.0
0.0
0.0
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Per Capita Spending US$
$6,347
$6,500
$4,500
$3,251$3,306$3,460
$2,474
$2,580
$2,500
$500
-$1,500
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SOURCE: Health Affairs, V 28, 5, 2009, p1311
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Consumer- Emerging View
Changing Role
• Consumer choice
• New market entrants
• Price sensitive
• 4 of 5 bankruptcies in 08
• Richer array of services
• Consolidated
broker/integrators
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Macro Reform: Change the Model or…
Practice
Model
Prevent
Diagnosis
Treat
Manage
Great leverage
•Training
Expensive
Long-term
•Money
Good models
Consumer
driven
•Technology
Professional
role
Practice
Models
•Consumer
•Self-help groups
•Dx centers
•Start of life
•End of life
•Oral health
•Self tests
•Drug delivery
•Chronic disease
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What does it take to keep the paradigm
going?
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Transition
Tomorrow
• Chronic prevention and
management
Today
• Price competitive
• Acute treatment
• Consumer responsive
• Cost unaware
• Ambulatory – Home
and Community
• Professional prerogative
• In-patient
• Individual profession
Strategic
• Team
• Evidence based
Success
practice
• Traditional practice
• Information as tool
• Information as record
• Consumer engagement
and accountability
• Patient passivity
Source: Center for the Health Professions, UCSF.
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More Help At:
•Leadership
•Research
•Data
•Policy analysis
•Opinion
HTTP://FUTUREHEALTH.UCSF.EDU
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