Transcript PowerPoint - Modern Health Care Organizations

International Variations in Health
Care Expenditure
Todd Gilmer, PhD
Professor of Health Policy and Economics
Department of Family and Preventive Medicine
1
Increasing Health Care
Expenditures
2
National Health Expenditures as
a Percentage of GDP, 1960-2017
2019
19.3%
2009
17.3%
2009
$2.5 trillion
SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group. 9/2010
3
Why might this be a problem?
• Crowd out of public funds and opportunity
costs facing federal and state governments
• Increasing rate of uninsured
• Increasing burden on the poor
• Some spending may be wasteful
– International variations
4
Distribution of National Health Expenditures, by Type of
Service, 2008
Other Health
Spending
16.5%
Other Personal
Health Care
12.9%
Home Health
Care, 2.8%
Nursing Home
Care, 5.9%
Prescription
Drugs
10.0%
Hospital Care
30.7%
Physician/
Clinical
Services
21.2%
Note: Other Personal Health Care includes, for example, dental and other professional health services, durable medical equipment,
etc. Other Health Spending includes, for example, administration and net cost of private health insurance, public health activity,
research, and structures and equipment, etc.
Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the
Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; National Health 5
Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).
The Burden Of Public Spending, As Percentage Of Income, Nationally And By Income
Quintile, 2004.
Ketsche P et al. Health Aff 2011;30:1637-1646
©2011 by Project HOPE - The People-to-People Health Foundation, Inc.
The Burden Of Medicare Versus Medicaid/Children’s Health Insurance Program (CHIP)
Spending, As Percentage Of Income, Nationally And By Income Quintile, 2004.
Ketsche P et al. Health Aff 2011;30:1637-1646
©2011 by Project HOPE - The People-to-People Health Foundation, Inc.
The Burden Of Premiums, As Percentage Of Income, Nationally And By Income Quintile, 2004.
Ketsche P et al. Health Aff 2011;30:1637-1646
©2011 by Project HOPE - The People-to-People Health Foundation, Inc.
Federal and State Revenues and
Expenditures
11
12
13
14
15
Cross Country Variation in Health
Care Expenditures
16
US
Switzerland
OECD
Mean
UK
Organization of Economic Cooperation and Development
Publication: R. E. Leu, F. F. H. Rutten, W. Brouwer et al., The Swiss and Dutch Health Insurance Systems: Universal Coverage and Regulated Competitive
Insurance Markets, The Commonwealth Fund, January 2009
THE
COMMONWEALTH
FUND
17
Health Care Costs in US vs. OECD
• Compare US and OECD countries on health
care spending, workforce, treatment
intensity, and outcomes
• Source: Anderson et al. “It’s the prices,
stupid: Why the United States is so different
from other countries.” Health Affairs. 22(3)
Total Spending in 2000
(US$ PPP)
5000
4500
4000
3500
3000
2500
2000
1500
1000
500
0
New
Zealand
United
Kingdom
Japan
France
Norway
Canada
Germany
Switzerland
United
States
Percent of GDP, 2000
14
13
12
10
8
7.3
7.8
10.7
Germany
Switzerland
9.7
9.5
8
10.6
7.8
6
4
2
0
New
Zealand
United
Kingdom
Japan
France
Norway
Canada
United
States
% Private Spending
60
55.7
50
44.4
40
30
28
23.3
22
24.9
24
19
20
14.8
10
0
New
Zealand
United
Kingdom
Japan
France
Norway
Canada
Germany
Switzerland
United
States
Population Age 65+
20
18
17.2
16
15.8
16
16.4
15.4
16
14
12.6
12
12.3
11.7
10
8
6
4
2
0
New
Zealand
United
Kingdom
Japan
France
Norway
Canada
Germany
Switzerland
United
States
Workforce
(per 1,000 in 2000)
12
10
8
6
4
2
0
New
Zealand
United
Kingdom
Japan
France
Norway
Nurses
Canada
Physicians
Germany
Switzerland
United
States
Coronary Angioplasties (per
100,000, 1999)
450
388.1
400
350
300
250
200
165.7
150
100
65.5
50
80.8
51
0
New Zealand
United Kingdom
Canada
Germany
United States
Life Expectancy at Birth
(2000-2005, UN)
86
85
84
83
83
82
82
82
81
81
81
80
80
78
78
78
77
77
76
76
76
76
77
75
74
72
70
New
Zealand
United
Kingdom
Japan
France
Norway
Canada
Germany
Switzerland
United
States
Physician Fees, US vs. Other
Countries
• Compare 6 countries on physician fees for
primary care and orthopedic surgery
• Source: Laugesen and Glied. “Higher fees
paid to US physicians drive higher spending
for physician services compared to other
countries.” Health Affairs. 30(9)
Primary Care And Orthopedic Surgery And Fees In Six Countries, 2008,
Relative to the US
2
1.8
1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
0
Public Payer Fee for Office Visit
Private Payer Fee for Office Visit
Australia
Canada
France
Office Visits per Capita
Germany
UK
US
Hip Replacements per 100k
Physician Capacity, Earnings, And Spending In Six Countries, 2008,
Relative to the US
2
1.8
1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
0
Primary Care Physicians Ortho Surgeons per 100k
per 100k
Primary Care Earnings
Australia
Canada
France
Ortho Surgeon Earnings
Germany
UK
Pmts to Primary Care
Physicians
US
Pmts to Orthopedic
Surgeons