Transcript Slide 1

Jesse D. Ibarra Jr. M.D.
Lectureship
in
International Health
Jesse D. Ibarra Jr. M.D.
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Native of Leon, Mexico
National University of Mexico
Internship & Residency - S&W
Senior Staff S&W - 1950 Endocrinology
Clinic Board of Directors 1973-1984
VP Clinic Board for 5 years
Special Projects Committee
Jesse D. Ibarra Jr. M.D.
• President S&W Health Plan 1984-1989
• Member State Board of Medical
Examiners 1977 - 1988
• Retired from S&W 1988
• Latin American Task Force until 1999
TECHNOLOGY
and the
FUTURE of HEALTHCARE
Ronald R. Blanck, D.O.
LTG, USA (Retired)
President
University of North Texas Health Science Center
Medicine Today
Unprecedented Growth in
● Technology
● Choices in Treatment Modalities
● Evidence – Based Medicine
● Diagnostic Tools
Healthcare Today
Technology
● Procedures
● Pharmaceuticals
● Blood Products
● Imaging
● Information
Growth in National Health Expenditures
Nominal health expenditure growth is projected to exceed the growth of the mid- to late
1990s, b ut fall short of the growth experienced in the late 1980s.
18
Actual
16
Projected
14
Percen t
12
10
8
Nominal
6
Real
4
2
0
1980
1985
1990
1995
2000
2005
2010
Calendar Years
Note: Nominal: values expressed in current dollar terms (not adjusted for inflation). Real: values deflated by the GDP chain-weighted
price index.
Source:
CMS, Office of the Actuary, National Health Statistics Group.
June 2002 Edition
Centers for Medicare & Medicaid Services
Section I. Page
24
National Health Expenditures as a Share of
Gross Domestic Product (GDP)
Between 2001 and 2011, health spending is projected to grow 2.5 percent per year faster
than GDP, so that by 2011 it will constitute 17 percent of GDP.
20
Actual
Projected
Percen t o f G D P
18
16
14
12
10
8
1980
1985
1990
1995
2000
2005
2010
Calendar Years
Source:
CMS, Office of the Actuary, National Health Statistics Group
June 2002 Edition
.
Centers for Medicare & Medicaid Services
Section I. Page
25
Prescription Drug Expenditure Growth and Share of
National Health Expenditures
Sharply rising prescription drug expenditure growth nationwide in the mid- to late 1990s
caused noticeab le growth in prescription drugs as a share of total health spending.
20
18
17.3
16
Percen t
14
12.1
12
Growth
10
9.4
8
6
4.9
4
Share of NHE
2
0
1984
1989
1994
1999
Calendar Years
Source:
CMS, Office of the Actuary, National Health Statistics Group
June 2002 Edition
.
Centers for Medicare & Medicaid Services
Section I. Page
1
. . . And Unprecedented Growth In:
● Medical Costs (e.g. Meds, Procedures , Liability)
● Regulations (e.g. HIPPA, Multiple Payor Forms)
● Prescriptions per Patient
● Aging Population
● Under or Uninsured
● Emerging Diseases (e.g. Asthma, AIDS, TB)
Healthcare Expenditures
● Up 7.8% in 2002 to 1.674 Trillion (CMS)
● 14.9% of GDP in 2002
● At 1% over economic growth - 38% of
GDP in 2075
Healthcare Today
● Best Disease Care
● Complex
● Expensive
● Error - Prone
● Regulated
● Inaccessible to Many
GOLDEN AGE OF MEDICINE
. . . for Some
Person with Public and Private
Coverage, and the Uninsured,
1990-1999
200
Millions of persons
150
100
50
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
Uninsured
Source: HIAA, 1990-2000
Public coverage
Private coverage
The Uninsured
50
18%
45
16%
40
14%
35
12%
30
10%
25
8%
20
6%
15
4%
10
2%
5
0
0%
85
Source: US Census Bureau.
86
87
88
89
90
91
92
93
94
95
96
97
98
Number and Percent Uninsured
1985 - 2002
99
00
01
02
Percent of Total Population
Number of Uninsured in
Millions
The number of uninsured lives is on the rise again.
MEDICAL CARE IS . . .
DISEASE CARE RATHER
THEN HEALTH CARE
Healthcare Today
Our Health System is a NON-System
Emphasizing Disease By:
● Education
● Research
● Payment
Today’s preventive care allows
longer life, but more illnessrequiring more costly care
Health Care Cost
Focus on cost of reduction is
piecemeal and may be short-sighted:
e.g. reduced payments may be
counter-productive, potentially
reduces early care and access
Healthcare Cost (cont.)
Instead of only looking at cost reduction,
look at distribution . . . and efficiencies . . .
and what medical/health care is about:
● To heal
●
To maintain health/quality of life
Healthcare Costs (cont.)
Question Is How Best To Do:
● Medical (disease) care
● Preventive and early detection care
● Both Efficiently
Goal is to
Rationalize and systematize
medical and healthcare for
efficiency and quality of life
There is no system of medical
care in the U.S.
There is a System of
Healthcare - PUBLIC HEALTH
● Water Purification
● Food Safety
● Sanitation
● Immunizations
Biological Warfare
The intentional use of
microorganisms or toxins derived
from living organisms to produce
death or disease in humans,
animals or plants
BW Agreements
● 1925 Geneva Protocol
● 1969 Nixon renounces BW
● 1972 Biological Weapons Convention
● 1975 Geneva Conventions Ratified
Biological Weapons Policy
● No use under any circumstance
● Research limited to defensive measures
● We possess NO weaponized biologicals
● Previous weapons stocks destroyed
● Destruction supervised:
- USDA
- Dept of HEW
- DNR of AR, CO, MD
The Sverdlovsk Incident
● April - May 1979
- 66 Anthrax fatalities
● 1988
- Soviets present data:
○ 96 cases
○ 79 gastrointestinal
● May 1992
- Yeltsin admits
“military developments”
Advantages of BW:
Are Biologicals the Ultimate Weapons?
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Agent easy to procure
Inexpensive to produce
Can disseminate at great distance
Agent clouds invisible
Detection quite difficult
First sign is illness
Overwhelms medical capabilities
Simple threat creates panic
Perpetrators escape before effects
Ideal terrorist weapon
Acquisition of Etiologic Agents
● Multiple Culture Collections
● Universities
● Commercial Supply Houses
● Foreign Laboratories
● Field Samples or Clinical Specimens
Hazardous Biological Material
● Letters
● Packages
● Cultures
● Person-to-person
● Airborne
Response
● Not Typical First Responders
● BIO First Responders
- Physician’s Office
- ER
- Clinics
- Public Health
● All Organizations Involved
Issues
● Rapid Detection
● Public Health
● Hospital Capacity
● Stockpiling
● Vaccine Production
. . . BIOTERRORISM HAS
CHANGED THE FOCUS OF
OUR APPROACH TO PUBLIC
HEALTH
Public Health In the Forefront
● Population Health
● Education
● Early Detection
● Immunizations
Steps to a System of Care
● Tort Reform
● Single Payor
● Linked Information Systems
● Lifetime Electronic Patient Records
● Change in Priorities for
- Education
- Research
- Payment
Future . . .
● Public Health; Prevention/Health Promotion
● New Paradigm of Care Based on
Linking:
Technology
Prevention
Efficiency
● Best use of $ Systematically
The end
Please continue to the post test
 Download the post test
 Complete the post test
 Send the post test to:

– Dr. Sandra Oliver
– 407 I TAMUII
Post Test Question 1
1. Which of the following statement regarding health care expenditures is
incorrect
A.
Up 7.8% in 2002 to 1.674 Trillion (CMS)
B.
14.9% of GDP in 2002
C.
Approximately 55 percent of Medicaid is financed by state funds
D.
At 1% over economic growth - 38% of GDP in 2075
Post test Question 2
2.
A.
B.
C.
Over the decade of the 90’s the
number of persons with private
health care coverage has:
Increased
Decreased
Remained upchanged
Post test question 3
3.
A.
B.
C.
D.
E.
Powers and duties of public health officers
include all of the following except:
Tertiary health care programs
Water Purification
Food Safety
Sanitation
Immunizations
Post test Question 4
4. According to R.R. Blanck, the first
responders to biological warfare will
be:
A. Infectious disease physicians
B. Firemen/EMT
C. Primary care providers
D. Toxicologists