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Common Challenges
US and Canadian Health Care
CSG – ERC August 9, 2011
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US Health SystemAccident of History
• Early US Veteran’s support • 1930’s Veteran’s Administration• 1940’s Employer Sponsored
Insurance• 1965 Medicare – over 65
Medicaid – low income• 1997 Children’s Health Insurance
(CHIP)• 2010 Affordable Care Act
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Our Hodgepodge System
• Costs more than other OECD countries
• Doesn’t cover everybody
• Far from seamless• Dismantling 80 years
of a piecemeal policy approach tremendous challenge
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International Comparison of Spending on Health, 1980–2008
0
1000
2000
3000
4000
5000
6000
7000
8000
19
80
19
81
19
82
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
United StatesNorwaySwitzerlandCanadaNetherlandsGermanyFranceDenmarkAustraliaSwedenUnited KingdomNew Zealand
Average spending on healthper capita ($US PPP)
0
2
4
6
8
10
12
14
16
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
United StatesFranceSwitzerlandGermanyCanadaNetherlandsNew ZealandDenmarkSwedenUnited KingdomNorwayAustralia
Total expenditures on healthas percent of GDP
Source: OECD Health Data 2010 (June 2010).
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Life Expectancy at Birth, 2007
81.1 80.782.282.382.382.482.983.083.083.784.084.284.4
78.2 77.1 75.477.278.077.278.278.978.479.078.479.277.5
0
10
20
30
40
50
60
70
80
90
FR SWITZ* ITA* AUS CAN* SWE NOR* GER* NETH OECDMedian
NZ UK** US*
Female Male
* 2006** 2005Source: OECD Health Data 2009 (June 2009).
Years
6
QUALITY
COSTACCESS
Balancing Needs and Viewpoints
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Let’s Look at Ourselves
• Canada• 34 million • 68% 15 – 64• 16% over 65• 81 – life expectancy
@birth• 81% population urban
• Source CIA World Factbook
• United States• 313 million• 67% 15 – 64• 13% over 65• 78 – life expectancy
@ birth• 82% population urban
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Out-of-Pocket Spending of $1,000 or More
in the Past Year, by Income
Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status.
* Indicates significant within-country differences with below-average income (p < 0.05).
31
17
510 11 11
16
2
34
0
45
1612
5 5 7 6
15
2
20
0
29
0
15
30
45
60
AUS* CAN* FR GER* NETH NZ* NOR SWE SWIZ* UK US*
Above-average income Below-average income
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
(Adjusted) percent
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Challenges
• Changing demographics
• Cost
• Workforce
• Improving delivery of care
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Changing demographics
• Ethnicity
• Age
• Languages spoken
• Generations
• Attracting workforce to deliver care to changing demographics
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Cost
CHALLENGES
Aging Boomers will drive volume regardless of financing approach
“80/20 rule” – lifestyle choices and chronic conditions
Fragmented care
Inefficient care – duplication etc.
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Workforce
• AAMC projects 91,500 shortage of physicians by 2020; nearly half primary care
• Health professionals are aging too!
• Supply and distribution problems
• BLS March 2011 healthcare sector added 37,000 new jobs – largest increase in any employment sector
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Looking Ahead - US
• Patient Centered Medical Home– Payment Reform– Scope of Practice
• Accountable Care Organizations– Team approach – best care, less spending– Evidence based medicine
• Technology – health information exchanges and electronic medical records
• Incentives – Loan Repayment
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CONTACT INFORMATION
Paula K. Roy
Executive Director
Delaware Health Care Commission
Margaret O’Neil Building
410 Federal St. Suite 7
Dover, DE 19901
302-739-2730
302-739-6927 fax
www.dhcc.delaware.gov