health care issues implications for our future march 2009

7/31/2019 Health Care Issues Implications for Our Future March 2009

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Kevin C. Moriarty, President & CEO

Methodist Healthcare Ministries

March 2009

Serving Humanity to Honor God

Health Care Issues: ImplicationsFor Our Future


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Methodist Healthcare Ministries

Mission to improve the health of least-served in South Texas

Half owner (with HCA) of MethodistHospital System

Provided $203 million in services since

inception


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Programs/Partnerships ofMethodist Healthcare

Ministries


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$4,300,000

$7,700,000$8,000,000

$9,400,000$10,500,000

$13,400,000

$15,600,000$17,000,000

$20,500,000

$32,400,000

$24,100,000

$40,900,000

$0

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

$30,000,000

$35,000,000

$40,000,000

$45,000,000

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008


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Bexar County Demographic ProfileBexar County Ethnic Composition

Total 1,594,493 100%

Hispanic 913,947 57%

Non HispanicWhite

512,490 32%

AfricanAmerican

111,059 7%

Other 37,818 3%

Source: San Antonio Health Profiles 2007Source: U.S. Census Bureau, 2007 American Community SurveySource Texas Department of State Health ServicesSource: Map came from Bexar County Health Collaborative athttp://www.healthcollaborative.net/assessment06/bexar-county-demographic/demo1.php


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Bexar County Demographics--Continued

Reported

Income Households PercentagesLess than$14999 80325 15%

$15,000 to$24,999 66757 12%

$25,000 to$34,999 69470 13%$35,000 to

$49,999 82496 15%$50,000 to

$74,999 100406 19%$75,000 to$99,999 57530 11%

$100,000 ormore 85752 16%

Source: San Antonio Health Profiles 2007Source: http://www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm

Bexar County Income 2007


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Bexar County Demographics--Continued

Behavioral Risk Factors: Local

7%

16%

23%

8%

11%

12%

23%

27%

13%12%

28%

38%

11%

14%

13%

36%

30%

20%

36%

5%

26%

21%

28%

0% 5% 10% 15% 20% 25% 30% 35% 40%

Diabetes

Current Smoker

Overweight

Asthma

No Health Insurance

Alcoh ol B inge

No Flu Shot age 65+

High Blood Pressure

Non Hispanic White Hispanic African American

San Antonio Metropolitan Statistical Area 2007

Source: San Antonio Health Profiles 2007

Source: http://www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm


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Bexar County

Bexar County Community Health Collaborative

2006 Health Assessment


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Bexar County


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Bexar County


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Health Care

Context


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Health Insurance: Yesterday & TodayNational Health Plan

This approach has been proposed as early as 1917, again

in the 30s and 40s and as well as todayEmployer Sponsored Health Insurance

In 1930 workplace coverage started by Blue Cross Blue

Shield (Dallas ISD) and Kaiser (CA.) Employers and employees utilize health care coverage

as a benefit to hire and keep employees.1940 only 9% had insurance,

1966 more than 80% had insurance

Today, we are the only industrialized nation withemployer based health insurance.


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$803

$472 $313$582

$396 $389$359

$2,572

$483 $342$354

$1,611$1,832$1,917

$2,176$1,940$2,350

$1,894

$2,475$2,210

$2727

$238

$239$370 $28

$113

$444

$906$148

$ 0

$ 1 , 0 0 0

$ 2 , 0 0 0

$ 3 , 0 0 0

$ 4 , 0 0 0

$ 5 , 0 0 0

$ 6 , 0 0 0

$ 7 , 0 0 0

U n i t e d

S t a t e s

C an ad a Fr an ce N et h er l an ds Ge rm a ny A u s t ra l i a U ni t e d

K i n g d o m

OECD

Med ian

J apan N ew

Z e a l a n d

Pr i v a t e Sp e n d i n g

Out -o f -Poc k e t Spen d in g

Pub l i c Spend i ng

Health Care Expenditure per Capita bySource of Funding in 2004

J. Cylus and G. F. Anderson, Multinational Comparisons of Health Systems Data, 2006(New York: The Commonwealth Fund,Apr. 2007).


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Americans Spend More Out-of-Pocketon Health Care Expenses, 2004

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$0 $100 $200 $300 $400 $500 $600 $700 $800 $900

a2003b2003 Tot a l Heal t h Care Spending, 2002 OOP Spending

Source: The Commonwealth Fund, calculated from OECD Health Data 2006.

France

Netherlands

Germany

New Zealand Japan

OECD Median

CanadaAustralia

United States


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Growth in National Health ExpendituresPCI 19802011*

1,067

4,177

5,400

9,216

0

2,000

4,000

6,000

8,000

10,000

1980 1998 2003 2011*Source: Levit et al. Health Affairs 2002;21:172181.

*Projection from Heffler et al. Health Affairs 2002;21:207218.


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Texas Rankings Global: 8th Largest economy in the

world.

2nd in wealth disparities between rich

and middle class

49th in overall spending.

36th in tax dollars returned fromfederal level.


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Texas: A Superior Place to DoBusiness

Texas is the headquarters to 45 Fortune 500Companies

Texas is the largest exporter in the nation

Has one of the lowest tax burdens in thecountry. An overall tax burden that is 32% lessthan the national average

Source Texas Governor Rick Perry Website


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Health Policy in Context:

Texas invests less per capita on the poor

$1.96 $6.78

$44.64

$74.58

0

10

20

30

40

50

60

70

80

Public Assistance, per Person in Poverty Spending on Medicaid, per Person in Poverty

Texas

A verage for U.S. States


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The Uninsured


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Health Care Economic Links


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Texas has the highest uninsured rate in

nation (25%) 75% offamilies have at least one familymember working full-time* Two-thirds are families earning less than

$35,000 annually

Only 10% of uninsured Texans are unemployed

UNINSURED and Employment

* Texas Health Institute, Kaiser Family Foundation (State Health Facts)


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Health Care Benefits by Industry (by %)

71

85

46

76

78

52

67

28

61

50

All Workers

Management &

Professional

Sales & Office

Construction &

Maintenance

Production

Acces s Participation

Source: DOL National Compensation Survey, March 2007


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National:

1999 2005: % of Workers with healthcosts greater than 10% of payroll *

38%

56%

0%

10%

20%

30%

40%

50%

60%

1999 2005

* Costs are health insurance and other health related costs.

Kaiser Family Foundation, Snapshots Health Care Costs: Employer Health Insurance Costs & Worker Compensation, March 2008


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Health Benefits by Business Size (%)

59

84

42

62

1 to 99 workers

100 workers or

more

Access Participation

Source: DOL National Compensation Survey, March 2007


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Deductibles Rise Sharply, Especially inSmall Firms, Over 20002007

1 8 7 2 1 0 1 5 7

4 6 1

6 6 7

3 8 2

$ 0

$ 1 5 0

$ 3 0 0

$ 4 5 0

$ 6 0 0

$ 7 5 0

$ 9 0 0

T o t a l Sm a l l f i rm s , 3 1 9 9

em p loy ees

La rge f i rm s , 20 0+

em p loy ees

2 0 0 0 2 0 0 7

PPO = preferred provider organization. PPOs covered 57 percent of workers enrolled in an employer-sponsored healthinsurance plan in 2007.Source: The Kaiser Family Foundation/Health Research and Educational Trust, Employer Health Benefits, 2000 and 2007

Annual Surveys.


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Total % Uninsured in Texas by County2000 and 2040

Texas State Data Center Project, funded by MHM. 2040Projections are based on assuming rates of migration are equal

to 1990-2000.


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Obesity: Can

We Afford it?


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Cost to Businesses of Obesity

For Texas businesses, adult obesity cost

more than $3.3 billion in 2005.

At current rates, obesity could cost Texasbusinesses $15.8 billion annually by 2025.

Source: Texas Comptroller of Accounts, cited by the San Antonio Business

Journal, January 23, 2009


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According to research recentlycommissioned by MHM:

2010: 356,187 obese adults (30.2%) 2020: 441,981 obese adults (33.0%) 2030: 562,689 obese adults (37.7%) 2040: 679,970 obese adults (42.7%)

Obesity Projectionsfor Bexar County

Source: State Demographer UTSA


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Some Costs of Diabetes It costs approximately six times as much to

provide medical care for a year to a diabetic asto a non-diabetic. (NIH, 2000)

In 2002, the cost of treating diabetics was $91.8billion nationally. This does not include indirect

costs (lost workdays, disability, etc.) of $39.8billion. Individuals with diabetes are 28 times more

likely to have a lower-limb amputation. Low-income individuals with disabilities and

huge hospital bills tend to become indigent carepatients.


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Flavored Milk in Schools

Substituting white

milk for chocolatemilk could result in achild losing 8 lbs.over 1 year allelse remaining thesame.

-Peggy Visio, Nutritionist,Get FIT Program of Methodist

Healthcare Ministries


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Income and Obesity

23% of lower-income people in the U.S. areobese

16% of the U.S. middle and upper classesare obese

(A Rotten Deal, Self, December 2003)


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Poverty Rates (%)

0-11%

12-15%

16-20%

21-29%

30-50%

Obesity Poverty

Source: State Demographer


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A dollar can buy 1,200 calories of cookies orpotato chips but only 250 calories of carrots.New York Times, April 2007, You Are What You Grow

Economics and Obesity


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Availability of Fresh Produce

Only 21% of convenience stores stock fruits

and vegetables New York Times, January 2006

3 times as many supermarkets in wealthyneighborhoods as in poor ones

American Journal of Preventive Medicine, 2002


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Income and Obesity

Many children living in poverty are obese even

though they eat fewer calories than dailyrequirements.

This is due to:

Micronutrient deficiency (lack of calcium,potassium, magnesium and phosphorus)

Sedentary habits(Social & Health Research Center, October 2008)


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Changes in Food Prices

1985-2000


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20102020

2030 2040

Obesity Projections for Texas

Source: State Demographer


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Health Care Workforce Issues


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Insufficient Supply of Dentists,Physicians, and Other

Healthcare Workers in Texas

70% of Texas 254 counties are designated asMedically Underserved Areas (MUA)

Texas facing unprecedented nursing shortage thatis projected to create a shortage of 71,000 full-timenurses by 2020

Shortage of medical educators

Source: MHM Legislative Agenda 2009


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Healthcare Policy Recommendations

Provide incentives to attract more health care

providers into MUAs

Support effective pipeline programs that advancehealth care professionals (MHM provided a $1.495 million

grant to the Alamo Community College Districts jointnursing program)

Support diversity in the Healthcare workforce

health care issues implications for our future march 2009

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