Transcript Public social expenditure by broad social policy area in percentage

1
MICHAEL D. WILLIAMS, MD FACS
DIRECTOR OF THE CENTER FOR HEALTH POLICY
THE FRANK BATTEN SCHOOL FOR LEADERSHIP AND PUBLIC POLICY
ASSOCIATE CHIEF MEDICAL OFFICER, UVA HEALTH SYSTEM
ASSOCIATE PROFESSOR OF SURGERY AND PUBLIC HEALTH SCIENCES
SOCIAL IMPERATIVE
• The Great Question: How do we make Health and Wellness:
• Achievable
• Equitable
• Sustainable
For every American?
3
Too Fat to Fight: Is the Obesity
Crisis a National Security Risk?
by Andrea King Collier
4
"By the year 2020,
only two out of
every 10 recruits
will be able to meet
the weight-fitness
qualifications to
serve." — Dr.
Gregory Poland"
According to Poland, "one in three young adults of military
recruitment age in the United States is too overweight to enlist.
"In fact, obesity and overweight is the No. 1 cause of ineligibility
in the armed services," he says. "By the year 2020, only two out
of every 10 recruits will be able to meet the weight-fitness
qualifications to serve."
5
Patient
Goals
Payer
Expenses
6
Value
Provider
Costs
7
8
9
10
11
12
Per Enrollee
Second…
Social Determinants of Health
•Availability of resources to meet daily needs (e.g.,
safe housing and local food markets)
•Access to educational, economic, and job
opportunities
•Access to health care services
•Quality of education and job training
•Availability of community-based resources in
support of community living and opportunities for
recreational and leisure-time activities
•Transportation options
•Public safety
•Social support
•Social norms and attitudes (e.g., discrimination,
racism, and distrust of government)
•Exposure to crime, violence, and social disorder
(e.g., presence of trash and lack of cooperation in
a community)
•Socioeconomic conditions (e.g., concentrated
poverty and the stressful conditions that
accompany it)
•Residential segregation
•Language/Literacy
•Access to mass media and emerging technologies
(e.g., cell phones, the Internet, and social media)
•Culture
18
20
21
-Healthcare Financial Management
Association website
22
23
FUTURE STATE
•
•
•
•
24
State Governments will likely have More Control
State Spending on Health Care will continue to
increase
Social Determinants will continue to have an
outsized impact on expenditures
Opportunities/Imperatives for Creative Programs
that Mitigate SD’s
•
•
=More Risk
=Likely Greater Disproportionate Spending
•
=“Healthcare” Dollars may need to spent
Indirectly
=Public/Private/Academic Partnerships may
be the path forward
•
Public social expenditure by broad social policy
area in percentage of GDP, 2003 – OECD
25
Public and private social expenditure in
percentage of GDP, 2009 – OECD
27
28
29
30
31
33
SOLUTIONS
•
•
•
36
Educate Providers
– Costs of Therapies (Robotics)
– Value Points/patient/population
Educate Policymakers
– Value Point
– Comprehensive Cost of new Policies (HIPPA, MACRA ,etc)
Educate Patients
– Goal-sharing indexed to Value Point/ Therapy
– Right-size Expectations (Everyone Dies Rule)
– Direct, personal and shared COSTS!!!!( No Free Lunch…)
37