health care reform: challenges and opportunities marian mulkey, mpp, mph california healthcare...

Health Care Reform: Challenges and Opportunities

Marian Mulkey, MPP, MPHCalifornia HealthCare Foundation

www.chcf.org

State Association of County Retirement SystemsSpring Conference

May 15, 2009

CALIFORNIA HEALTHCARE FOUNDATION

The Problems

Rising health care costs Growing population of uninsured Declining rate of employer-sponsored

insurance Ongoing concerns with health care quality


Health spending represents a growing share of the US economy.

Slide #3 of HC Costs 101, 2008


In the US, health care spending is split between private and public sector.


Most non-elderly Californians receive health coverage through employment…

Source: California HealthCare Foundation, Snapshot: California’s Uninsured, 2008.

Subsitute Slide 4, Unins snapshot 2008


Yet employer-based coverage is steadily declining, and more are uninsured.

Source: California HealthCare Foundation, Snapshot: California’s Uninsured, 2008. www.chcf.org/documents/insurance/CAUninsured08.pdf


The uninsured are less likely to get the care they need.

Source: Kaiser Family Foundation, The Uninsured: A Primer, October 2006


Adherence to Quality Indicators

10.5%

22.8%

32.7%

40.7%

45.2%

45.4%

48.6%

53.0%

53.5%

53.9%

57.2%

57.7%

63.9%

64.7%

68.0%

68.5%

73.0%

75.7%

0% 20% 40% 60% 80% 100%

Alcohol Dependence

Hip Fracture

Ulcers

Urinary Tract Infection

Headache

Diabetes Mellitus

Hyperlipidemia

Benign Prostatic Hyperplasia

Asthma

Colorectal Cancer

Orthopedic Conditions

Depression

Congestive Heart Failure

Hypertension

Coronary Artery Disease

Low Back Pain

Prenatal Care

Breast Cancer

Percentage of Recommended Care Received

Nationwide, on average adults receive recommended care less than half the time.

Percentage of Adults Receiving Recommended Care, by Type

54.9% = Overall care 54.9% = Preventive care 53.5% = Acute care 56.1% = Chronic care

Source: McGlynn EA, et al., “The Quality of Health Care Delivered to Adults in the United States,” New England Journal of Medicine, Vol. 348, No. 26, June 26, 2003, pp. 2635-2645


Higher spending doesn’t necessarily mean higher quality

California


Premium and out-of-pocket expenses add up for consumers


Health care expenses represent a substantial share of income


Some policy approaches and ideas

Broad coverage expansion Employers required to provide coverage (“pay or play”) Individuals mandated to buy, insurers required to sell Single payer (all participate, broad tax-based financing)

Other proposals Reduce insurance and/or employer regulation Make consumers more aware of prices Reduce health care provider administrative burden Use health information technology to better manage care Change provider payments to reward “performance”

rather than volume Directly regulate new technology, and/or prices And on, and on…


Many groups have a stake in the health reform debate

Hospitals, doctors, and other health care providers Employers Labor unions Insurance companies Government agencies: federal, state, local Consumer advocates Citizens

It’s much easier to agree that current system needs reform, than to agree on who should pay more or

be obligated to behave differently to change it.


Health Reform: Key Issues and Challenges

Coverage expansion addresses one aspect of larger set of problems

Who should pay? Who should be subject to mandates or other new requirements?

How should “affordability” be defined for: Employers Employees/ Individuals Government

How should “quality” be defined and monitored? How can costs be contained and quality improved,

now and in future?


What’s next?

health care reform: challenges and opportunities marian mulkey, mpp, mph california healthcare...

Documents

health care spending

quality of health care

health care reform

acute care

preventive care

overall care

health coverage

kaiser family foundation