1 int’l models of coverage...or, what monty python can teach barack obama about health care reform...

1

Int’l Models of Coverage...or, what Monty Python can teach Barack Obama

about health care reform

Jonathan CohnSenior Editor, The New Republic

15

THE COMMONWEALTH FUND

Percent AUS CAN FR GER NETH NZ UK US

Did not fill Rx orskipped doses 20 18 13 12 3 18 7 43

Did not visit a doctor when had a medical problem 21 9 11 15 3 22 4 36

Did not get recommended test, treatment, or follow-up 25 11 13 13 3 18 6 38

Any of the aboveaccess problems because of cost 36 25 23 26 7 31 13 54

Data collection: Harris Interactive, Inc.Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

Base: Adults with any chronic condition

Cost-Related Access Problems

3

Spending as % GDP

Doctor Visits

Source: OECD

8

THE COMMONWEALTH FUND

Percent AUS CAN FR GER NETH NZ UK US

Test results/recordsnot available at timeof appointment 16 19 15 12 11 17 15 24

Duplicate tests: doctors ordered test that had already been done 12 11 10 18 4 10 7 20

Either/both coordination problems 23 25 22 26 14 21 20 34

Data collection: Harris Interactive, Inc.Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

Base: Adults with any chronic condition

Coordinated Care

10

THE COMMONWEALTH FUND

Base: Adults with diabetes

Percent received all four diabetes services*

Data collection: Harris Interactive, Inc.Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

* Hemoglobin A1c checked in past six months; feet examined for sores or irritations in past year; eye exam for diabetes in past year; and cholesterol checked in past year.

Basic Diabetes Care

Source: McKinsey Global Institute http://www.mckinsey.com/mgi/rp/healthcare/accounting_cost_healthcare.asp

Waiting Times

5

THE COMMONWEALTH FUND

Same-day appointment 6+ days wait or never ableto get appointment

Data collection: Harris Interactive, Inc.Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

Base: Adults with any chronic condition (Percent)

Waiting Times, Cont’d

6

THE COMMONWEALTH FUND

Less than 4 weeks Two months or longer

Data collection: Harris Interactive, Inc.Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

Base: Adults with any chronic condition who needed to see a specialist in past 2 years (Percent)

Waiting Times, Cont’d Again

7

THE COMMONWEALTH FUND

Base: Adults with any chronic condition who needed after-hours care

Percent reported very/somewhat difficult getting care on nights, weekends, or holidays without going to ER

Data collection: Harris Interactive, Inc.Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

6256 56

3630

3944

60

Urgent Care Issues

CT Scanners

Source: OECD

Ortho Procedures

Source: McKinsey Global Institute http://www.mckinsey.com/mgi/rp/healthcare/accounting_cost_healthcare.asp

Life Expectancy

Source: OECD

Life Expectancy After 65

Source: OECD

Potential Years of Life Lost

Source: OECD

16

Cancer Survival, Part 1

Source: Coleman et al, Lancet Oncology

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Cancer Survival, Part 2

Source: Coleman et al, Lancet Oncology

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Cancer Survival, Part 3

Source: Gerard Anderson, JHU

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THE COMMONWEALTH FUND

Percent AUS CAN FR GER NETH NZ UK US

Only minor changes needed 22 32 41 21 42 29 38 20

Fundamental changes needed 57 50 33 51 46 48 48 46

Rebuild completely 20 16 23 26 9 21 12 33

Data collection: Harris Interactive, Inc.Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

Base: Adults with any chronic condition

Perceptions of Health Systems

OH, CANADAPure single-payer (or pretty damn close to it)

The Good•Financial protection•Equity•Primary care•Continuity of care

The Bad•Waiting times•Rigidity

ARS Question 13: Follow-up

Overall, how do you believe the healthcare system in Canada compares to the United States system in cost, coverage and care?

A. Much betterB. Somewhat betterC. Same as USD. Somewhat worseE. Much worse

LONDON FOGNationalized medicine with a stiff upper lip

The Good•Financial protection•Equity•Primary Care•NICE is nice

The Bad•Waiting times•Speciality Care

ARS Question 14: Follow-up

Overall, how do you believe the healthcare system in the United Kingdom compares to the United States system in cost, coverage and care?

A. Much betterB. Somewhat betterC. Same as USD. Somewhat worseE. Much worse

ARS Question 15: Follow-up

Do you believe that the United States should adopt a similar institute for studying the comparative effectiveness of treatments/care?

A. YesB. Yes, but US system should not limit care as much as the UK.C. No

DUTCH TREATA health insurance market that works. (We

think.)

The Good•Financial protection•Equity with choice•Primary care•Continuity of care•Quality incentives•After-hours care

The Bad•Mandate gaps•Worries about risk selection

ARS Question 16: Follow-up

Overall, how do you believe the healthcare system in Holland compares to the United States system in cost, coverage and care?

A. Much betterB. Somewhat betterC. Same as USD. Somewhat worseC. Much worse

ARS Question 17: Follow-up

The United States should adopt quality and efficiency incentives similar to Holland?

A. Strongly AgreeB. Somewhat AgreeC. Somewhat DisagreeD. Strongly Disagree

FRENCH KISSIf Medicare were served with a fine

Bordeaux

The Good•Financial protection•Equity plus choice•Primary care•High-tech care•Choice and convenience

The Bad•Overtreatment•Poor continuity•Rural/urban disparities•Quality incentives

ARS Question 18: Follow-up

Overall, how do you believe the healthcare system in France compares to the United States system in cost, coverage and care?

A. Much betterB. Somewhat betterC. Same as USD. Somewhat worseE. Much worse

ARS Question 19: Follow-up

The United States should adopt a system similar to France, which is very close to the Medicare system in the United States?

A. Strongly AgreeB. Somewhat AgreeC. Somewhat DisagreeD. Strongly Disagree

HEALTH REFORM, IMAGINEDI.e., if Jonathan were king

Key elements•Insurance structure and financing levels of France•Quality incentives and care management of Holland•Comparative effectiveness of Britain•Provider choice of Canada•Public research funding and institutions of U.S.

HEALTH REFORM, REALITYI.e., because the filibuster is king

Key elements of Obama/Baucus/Kennedy•Retain employer-sponsored insurance•Pooling for small business and individuals•Public plan option•IT, comparative effectiveness, incentives for quality•Financed by taxes + employer mandate•Individual mandate maybe

Key elements of Wyden/Bennett•Transition from employer to individual insurance•Pooling for everybody•No public plan; private insurers as regulated utility•Individual mandate for sure

ARS Question 21: Follow-up

After hearing about consensus plan efforts at the federal level, do you believe they are headed in the right direction?

A. YesB. No, not extensive enoughC. No, this is the wrong directionD. Unclear, not enough information

A Word From Our Sponsor (Er, Speaker)

To read the book Sick, visit www.sickthebook.com

To follow the health care debate, visit www.tnr.com/thetreatment

To contact the speaker, e-mail jcohn@tnr.com