Integrating Public Health and Safety Net Care

Healthcare Safety Net Initiatives: Policy and PerformanceEduardo Sanchez, M.D., M.P.H.

Director, Institute for Health PolicyUT School of Public Health

February 9, 2007

National Health Spending$6,697 per person per year

 

• National Health Spending In 2005: The Slowdown Continues • Aaron Catlin, Cathy Cowan, Stephen Heffler, Benjamin Washington

the National Health Expenditure Accounts Team • In 2005, U.S. health care spending increased 6.9 percent to

almost $2.0 trillion, or $6,697 per person. The health care portion of gross domestic product (GDP) was 16.0 percent, slightly higher than the 15.9 percent share in 2004. This third consecutive year of slower health spending growth was largely driven by prescription drug expenditures. Spending for hospital and physician and clinical services grew at similar rates as they did in 2004.

• Health Affairs, 26, no. 1 (2007): 142-153

The Price is Not Right

U.S. Ranking:

Health Care Spending 1st

Life Expectancy 28th

In comparison of 6 similar countries* the U.S. ranked last in:

Patient safety, efficiency, equity, and patient centeredness

Source: The World Health Report 2003, Total Population at Birth. Commonwealth Fund studies, 2004, 2005

*Australia, Canada, Germany, New Zealand, U. Kingdom

Texas Perspectives #1

• An aging population with increasing medical care costs

• An increasing Hispanic population

• An epidemic of obesity

• An explosion of type 2 diabetes

Texas Perspectives #2• A shortage of healthcare providers

• Wide, and in some cases, growing health disparities

• The challenge of improving health literacy

• The highest % of residents without health insurance

POPULATION HEALTH (Kindig and Stoddart, 2003)

• “the health outcomes of a group of individuals, including the distribution of such outcomes within the group”

• “the field of population health includes health outcomes, patterns of health determinants and interventions that link these two”

The role of government

• Public Health

• Medical Care Safety Net

• A shared responsibility – the notion of systems

PUBLIC HEALTH(Institute of Medicine, 1988)

• “What we, as a society, do collectively to assure the conditions in which people can be healthy”

• The means by which we achieve population health?

Spiral of Health Cost Increases with

High Numbers of UninsuredUninsured utilize higher

than necessary levels of care

More uninsured

More employers drop coveragebecause of high premiums

Insurance companiesRaise premiums for insured

Increased chargesto paying customers

Higheruncompensated costs

How can the spiral be interrupted?

• Reduce the number of uninsured– Increase numbers of eligible and enrolled in

Medicaid/CHIP/state or local government programs

– Make insurance more accessible/affordable • Individually purchased• Employer provided

– Necessary but not sufficient

The Healthcare Equation is Out of Balance

Demand• Older• Heavier• More Sedentary• Un & Underinsured• Health Illiterate

Supply• Increasing Access • Increasing Workforce• System Redesign • Improving Quality of Care • Improving Technology • Improving Meds

Demand Reduction Is Imperative

How can the healthcare equation be balanced (the spiral be interrupted)?

• Improve population health– Traditional and chronic disease-focused

public health– School-based health education and

management– Worker health promotion (worksite wellness)

Supply

• Increasing Access

• Increasing Workforce

• System Redesign

• Improving Quality of Care

• Improving Technology

• Improving Meds

Demand Reduction Is Imperative

Health PromotionHealth Promotion• Health literacy initiativesHealth literacy initiatives

• Healthier lifestylesHealthier lifestyles

• Access to care (clinical Access to care (clinical

preventive services)preventive services)

The Healthcare Equation is Out of Balance

How can the healthcare equation be balanced ?

• Improve the health care delivery system– Invest in and connect to public health– Primary-care centered health system

Patient Centered Medical Home (mental/dental/medical)1. Easy access2. Continuity of care3. Comprehensive care4. Coordination of all care(Includes disease management)

TobaccoPrevention

And Cessation

ComprehensiveSchool Heath

Education

Worker and WorksiteWellness

Specialty Care

Diagnostic Testing

Hospital BasedCare

Inpatient Care

Emergency and trauma care

Primary-care Centered Health System

Public Health

Primary Care Specialty/Tertiary Care

Medical Care

Concept

= Optimal Communication (Integrated Virtual System)

Including best use of health informational technology

Conclusion: Policy and Performance

• Policy – a healthcare delivery system that integrates public health and medical care

• Performance measures– Population health status– Individual health status