over view for the health system

8/2/2019 Over View for the Health System

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Over view for the health system

and

Ahmed M. Rashad

the primary careUnitedpractice in the

States


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Most expensive in the world Technology is key driver

Insurance coverage is often linked toemployment

For most, insurance coverage isvoluntary

More than 45 million Americans areuninsured

Spend more per capita (almost $6,000)and a higher % of GDP (about 15%) on

health care than every otherindustrialized country

Basic Facts About U.S. HealthCare System


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Premiums

InsuranceEmployer

Government

Out of Pocket Payments

Providers

U.S. Health Care System is verycomplex


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U. S. Health Insurance Coverage

2000

10.3%

13.3%

8.30%

64.1%

14.0%

Employer Private Insurance Medicare

Medicaid Uninsured


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Where Does US Spending Come)2003From (

36.0%

16.0%

11.0%

33.0%

4.0%

Pvt. Ins. Out-of-Pocket State Federal Other


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Per Capita Growth In HealthCare Expenditures 1970-2001

(Trendline calculated for period 1970 1997)

0

200

400

600

800

1000

1200

1400

1600

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002


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Primary Care Physicians

It has been addresses by theWHOsince the 1940s as a policy toachieve universal affordable medicalcoverage.

Definition

healthaccessible,integratedthe provision ofcare services by clinicians that are accountable

of personallarge majorityfor addressing

healthcare needs, developing sustainedpartnership with patients, and practicing in thecontext of family and community.


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Who is practicing primaryhealthcare in the US

0%

10%

20%

30%40%

50%

Family

Doctor

Internal

Medicine

Pediatrics Ob & Gyn

Series1


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High demand for the PrimaryCare Practice in the US

About 15%, of the American population areuninsured.

about 20% lacking the usual healthcare servicesdue to the double digit rise in the healthinsurance premiums.

Poor quality Raising complain about the disparities in

healthcare services is a dangerous issues.

Weak infrastructure and adequacyof health force is uncertain.

Healthcare system is highlyfragmented.


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Qualitative Demand

Primary Care Practice can provide, if welldesigned, a comprehensive solution for most ofthese problems.

Strong primary care infrastructure can provideequitable cost-effective health care as it canreach to the low income groups of thecommunity and support them with the basicmedical care.

Primary care base healthcare delivery system

has the ability to improve quality while reducingcost.


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Quantitative Demand

The Primary Care Physician (PCP) in theUnited States needs 10.6 hours per day todeliver the recommended care for chronicpatients, plus 7.4 hours per day to providepreventive care to an average panel of 2500

patient which is less than the mean US panelsize by about 800 patients About 80 million patients are in need for the

PCP to get his/her permission for the

laboratory, radiology, and specialist services. Thirty three percent of patients failed to havean appointment with their PCP in 2003 raisedfrom 23% in 1997.


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The development of Managed CareOrganizationduring the 90s and the need for theprimary care doctor gate keeperfunction.

Decreasingjob satisfactionand the increase inthe educational debit and salary disparity, createa strong sense that becoming a primary caredoctor a strange errand.

The Perceived Market Need

Primary care practice in the US is

marketevolving as a result ofand not due topressure

structural governmental activities


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Not attractive specialty

The percentage of the US medical school graduatesentering the primary care field dropped to 38% in 2006

from 50% in 1998. The percentage of the 3rd year residents in internal

medicine planning to become primary physiciansdropped from 54% to 27% for the same period.

Specialties portion increased from 32% to 38%; primary

care portion declined by 3% from 1995 to 2003. Number of US medical students entering family practice

reduced by 50% between 1997 and 2005 and 80% ofphysicians enters it in 1998 became sub specialists orhospitalists.

Medical Students do notlike to work as a

Primary CarePhysicians


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Not attractive specialty

Percent Change between 1998 and 2006 in the Percentage of U.S. Medical SchoolGraduates Filling Residency Positions in Various Specialties .Data are from the National Resident Matching Program .


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Underlying causes of the problem

Primary care physician is the lowest earning in theUnited States among other medical specialties.

Medicare increased rates for doctors by 13% from1995 to 2003 while the inflation rate was 21% for thesame period.

Private payment and Medicaid even has laggedmore than this.

Physicians salaries has been declined by average7% after adjusting to inflation and primary caredoctors income reduced by 10.2% .

No serious proposals tonarrow the gap between

primary care physiciansand specialties are on the

national agenda


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Data are from the Medical Group Management Association Physician Compensation andProduction Survey, 1998 and 2005

Underpaid Specialty


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Underpaid Specialty


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High workload Unsatisfying academic image is important contributingfactors.

Primary Care Practice is not viewed as high nichespecialty and not appreciated in medical academic field

compared to other specialties. Medical students spent most of their life times asexcellent highly ranked students and it is not easy toassume that their personal trait accept to continue therest of their lives working in a low ranked profession.

Number of satisfied PC

doctors reduced by12% from 1991 to 1996

Underlying causes of the problem


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How the US address the problem:

should include actions on

both the primary carepractice side (micro-system improvement)and the healthcaresystem side (macrosystem-reform).


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The Futures of Family Medicine (FFM)project

Patient-centered team approach

Elimination of barriers to access Including an electronic health record

More functional offices

Focus on quality and outcomes Enhancing practice finance.

FFM project proposed new model forfamily practice (FP) characterized by


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5 challenges for the future of thispractice:

Promoting a broad more accurate understanding

of the specialty among the public Identifying areas for commonality in a specialty

whose strength is the wide scope and locallyadapted practice type

Winning the academic respect for this specialty Making the FP a more attractive career option

Addressing the publics perception that the FP is

not solidly grounded in science and technology



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It is the comprehensive management ofthe problem

the high complexity in both design andimplementation may make them moretheoretical than practical solutions.


Comments

It does not give direct solution for thelow income problems.

It also provides a kind of national project

for policy reform.


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Innovations in organizingtheprimary care provision

like Primary care teams; advanced access; thechronic care model; collaborative care; Groupmedical visits are proactive moves from the

PCP representative bodies. Quality of care and creating what is called best

of times are core values for these innovations,which are aiming at reduce the workload and

increase satisfaction of the primary caredoctors.


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Developing Hospitalists sub-specialty

one of the approaches has been takento improve the satisfaction anddecrease work load over the primary

care doctors through carrying out thefunction of taking care of the admittedprimary care patients.


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Recommendations


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over view for the health system

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