int’l models of coverage
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Int’l Models of Coverage. ...or, what Monty Python can teach Barack Obama about health care reform. Jonathan Cohn Senior Editor, The New Republic. 15. THE COMMONWEALTH FUND. Cost-Related Access Problems. Base: Adults with any chronic condition. - PowerPoint PPT PresentationTRANSCRIPT
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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
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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
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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 [email protected]