MGMT E-5520FOC:

Healthcare

MGMT E-5520FOC:

Healthcare

Stakeholder Presentation:

PatientsStakeholder Presentation:

Patients

Michelle Farnoush (& Alex Trebek)

Michelle Farnoush (& Alex Trebek)

Harvard University, 2010Harvard University, 2010

Patiens

I’ve got your back

The Gang

The System

We need to talk

Woe is me

Types

PatiensI’ve got

your back

Definition

Show me the

#’s

Stats

The Gang

The System

We need to

talk

Woe is me

Patiens: “I am suffering”

•Definition: Person who receives medical attention, care or treatment

•Alternative Terms: consumer, healthcare consumer, client, resident

Source: http://www.merriam-webster.com/dictionary/patient 2010

Types• Outpatient

• Ambulatory care

• <24 hrs

• Inpatient

• “Admitted”

• Indeterminate time

Source: http://content.mybenergy.com/ContentTemplates/WellnessTemplate.aspx?view=user&userid=101412&link=799

Show me the numbers

•US population (2010): 307, 006, 5001

•~58% insured

•~26% federal insurance

•~16% no insurance

1. Source: U.S. Census Bureau, Population Division

Stats•9.1% total population increase since 20001

•12.9% increase in 65 years+

•Inc in uninsured population in the past 5 years: 1 in 4 adults >50 yrs receives preventative care2

•39% increase in prescriptions dispensed

•6x the spending on prescriptions ($40B --> $234B)2

1. Source: U.S. Census Bureau, Population Division

2. Source: http://www.msnbc.msn.com/id/38727236/ns/health-forbescom/#

Stats•Commonwealth Fund: Where you live

matters

•Wealthier states = better care (NE)

•Poorer states = worse care (South)

•Access related to quality, but quality is not related to cost of care

Source: http://www.forbes.com/2007/06/14/health-hawaii-iowa-biz-wash-cx_bw_0615care.html

Types

PatiensI’ve got

your back

Definition

Show me the

#’s

Stats

The Gang

Medicare

Medicaid

TRICARE

Privacy, svp

Childrens &

Veterans

The System

We need to

talk

Woe is me

Privacy, s’il vous plait•Majority of health care

facilities

•Most health insurance (HMO)

•Private: 178 million people through work/self

•Federal insurance: 81 million

Source: Commonwealth Fund

1. Medicare•65 yrs+ and <65 with

medical disability

•Covers 47M Americans

•subsidy groups: Medigap

•Accounted for 12% federal spending & 23% total national health

•Financed via general revenues, payroll taxes, premiums

1. Medicare•Four Parts

•A: inpt, home health

•B: physician visits, outpt, preventive, home health

•C: Medicare Adv. program

(with HMO)

•D: voluntary/subsidized

outpt prescription

2. Medicaid•Helps pay for Medicare’s premiums

•Largest source of funding for health services: cost sharing for ~9M beneficiaries

•Administered by each state ex. MassHealth

•Included: low income, resident aliens,

Source: Medicaid General Information from the Centers for Medicare and Medicaid Services (CMS) website

3. TRICARE

•US Dept. of Defense Military Health System

•Managed under the Assistant Secretary of Defense (Health Affairs)

•Health benefits for civilian military personelle, retirees & their dependants

Source: TRICARE http://www.tricare.mil/, Task Force on the Future of Military Health Care: Final Report" (pdf). United States Department of Defense. 2007-12-20.

4. Children’s & Veterans•Children’s Health Insurance Program (SCHIP) 1

•matches funds to individual states for children’s health insurance in the Medicaid gap

•Expanded in 2009 to cover 4M children inc. immigrants

•Veteran’s Health Administration (VHA)2

•Medical assistance program for veterans through VA

•Renowned use of E-record

• 1. Source: "Children's Health Insurance Program". United States Department of Health and Human Services. Retrieved 09/10.

2. Source: "Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care" New England Journal of Medicine, May 29, 2003

Types

PatiensI’ve got

your back

Definition

Show me the

#’s

Stats

The Gang

Medicare

Medicaid

TRICARE

Privacy, svp

Childrens &

Veterans

The System

We need to

talk

Woe is me

Satisfaction

Minority Services

Goals

Satisfaction, not so guaranteed...

•How satisfied? Not very.

•2001 study in 5 states: medical debt accounted for 62% of all personal bankruptcies1

•inc in uninsured/underinsured: ER’s as safety net

•2/3 (63%) of uninsured confident they can’t pay

•WHO study - USA wins awards for:

•most expensive health care system(15% of GDP)

•lack of access, least fair in health funding1. Source: "Medical Debt Huge Bankruptcy Culprit - Study: It's Behind Six-In-Ten Personal Filings". CBS. 2009-06-05. Retrieved 09/10

2. World Health Organization, The World Health Report - Health Systems: Improving Performance. (Geneva: WHO, 2000).

Minority Services

•Minority vs disease specific services:

•African americans: higher infant mortality, 25% incidence of cancer

•Caucasian Americans: lower life expectancy than Asians

•Shifts focus of geographic-specific health care services (specialties) & satisfaction ratings (knowing whats covered)

Source: American Public Health Association (APHA), Eliminating Health Disparities: Toolkit (2004).

Pt. Goals•Better service

•faster appointments, less waiting times, more available doctors...

•Better care

•more preventive oriented, less “re-visits” and less “mistakes”...

•But...What’s better??

Types

PatiensI’ve got

your back

Definition

Show me the

#’s

Stats

The Gang

Medicare

Medicaid

TRICARE

Privacy, svp

Childrens &

Veterans

The System

We need to

talk

Woe is me

Satisfaction

Minority Services

Goals

Problems

Actions

Problems for Patients• Medicare spending expected growth of $519B to

$929B1

• Catering to the aging population: will increase Medicaid in-home & skilled nursing costs

• Satisfaction

• 89% of Americans satisfied with their healthcare, yet 49M are uninsured let alone the underinsured1

• Heaviest regulated industry in the US2

• Certificates of need: controls numbers&competition

• Services such as Medicare have shifted to controlling cost & limiting pt access31. Medicare at a Glance (Article #1066-13) The Henry J. Kaiser Family Foundation, Sept 2010. Retrieved from www.kff.org

2. Source: Christopher J. Conover (4-10-2004). "Health Care Regulation: A $169 Billion Hidden Tax" (PDF). Cato Policy Analysis 527: 1–32.3.Source: Alden Solovy, “goo, June 2006

Problems• Lack of Dr’s: AMA’s

100,000 yearly limit1

• Northeastern states have the “most” doctors/capita

• Mass 4.3

• Oklahoma & Idaho 1.6

1. Medical miscalculation creates doctor shortage, USA Today, March 2, 2005

Problems•Cost

•Rising cost of medical technology, prescription drugs1

•Admin costs from multipayer systems: 19-24% of health care spending (Canada is ~8%)2

•Non-profit to for profit health care providers: 34% increase in for-profit hospitals3: changes premiums

1. World Health Organization, The World Health Report - Health Systems: Improving Performance. (Geneva: WHO, 2000). 2. Source: Steffie Woolhandler, MD., MPH and David U. Himmelstein, MD., “ The Deteriorating Administrative Efficiency of the US Health Care System”; New England Journal of Medicine

324: 1253-1258 (May 2), 1991.3. Source: Steffie Woolhandler, MD., MPH and David U. Himmelstein, MD., “ Costs of Care and administration at For-profit and other hospitals in the US”; New England Journal of

Medicine 336: 769-774 (March 13), 1997.

Actions•Advocacy Groups: ACEP, AMA, Public Health Dept...

•blogs, polls, surveys after surveys, data analysis

• Independent patient reporting, political events

• Patient Bill of Rights: right to medical care1

• Patient Protection & Affordable Care Act (2010)2

• increased Medicaid eligibility, no past pt hx judgement, max out of pocket spending at min 2% of income

1. Source: http://www.acep.org/advocacy.aspx?LinkIdentifier=id&id=34546&fid=648&Mo=No

2. "Policies to Improve Affordability and Accountability". The White House.

Actions• Politics

• 6 registered health care lobbyists per congress member

• Campaigns waged partly through political donations1

• Individual State Acts: ex. Virginia prohibiting individual insurance requirement2

• Media:

• Pubic Arenas - open discussion forums

• Conference coverage

• Movies - mass distribution (education?) of selected (and edited) healthcare issues Ex. Sicko

1. McGreal, Chris (2009-10-01). "Revealed: millions spent by lobbyists fighting Obama health reforms". The Guardian (London). Retrieved 2010-09

2. "Letter from Cuccinelli to Pelosi". Retrieved 2010-09.

Actions•Health Care Reform

•ex. Reauthorization of SCHIP (2009)

•Public & Private groups: assess quality of care1

•Pay for Performance: details of what standard care should be

•Con: hospitals rush to adhere to guidelines (short term approach) with no long term systems in place nor employee “buy in”

Source: Robert Bazell. Satisfied with your Medical Care? Dont Be. http://www.msnbc.msn.com/id/18785138/

Types

PatiensI’ve got

your back

Definition

Show me the

#’s

Stats

The Gang

Medicare

Medicaid

TRICARE

Privacy, svp

Childrens &

Veterans

The System

We need to

talk

Woe is me

Satisfaction

Minority Services

Goals

Problems

Actions

Woe is me•Current Hot Topic:

•Universal Health System - it worked up north!

•Pro: Everyone get care (ideally...)

•Addresses the current cost problem of uninsured as hidden costs

•Con: Government controls care, heavier regulations, how do we consistently monitor changes, won’t necessarily mean better service!

1. Source:Llewellyn Edward Piper, PhD., 2005. Winning Loyalty with a vision and a corporate soul. The Health Care Manager. Volume 24 (4): 374-378

Woe is me•Other groups:

•Homeless: 664 million un/sheltered in 20081

•Medical Tourism: It’s cheaper elsewhere

•750, 000 Americans sought medical tx abroad in 20072

•E-patient boom: “I can treat myself”3

1.Source: U.S. Department of Housing and Urban Development, "The Annual Homeless Assessment Report to Congress (2008)", July 2009

2.Source: Linda A. Johnson, "Americans look abroad to save on health care: Medical tourism could jump tenfold in next decade," The San Francisco Chronicle, August 3, 2008

3. Masters K, Ng'ambi D, Todd, G (2010). ""I Found it on the Internet:" Preparing for the e-patient in Oman". SQU Med J 10 (2): 169–179.