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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.