PRESENTATION PREPARED BY SUSAN DOWNS KARKOS & MICHELE BAKER

NOVEMBER 19 2009

Introduction to Health Care

Goals of the session

Develop an understanding of the issues facing the U.S. healthcare system

Develop an understanding of some of the issues Colorado lawmakers are discussing today to reform health care

Develop an understanding of how government is involved in health care in the U.S. and Colorado

Recognize how important it is to have a voice in health care discussions and what you can do to participate

Health Care: What are the key areas that are being discussed for reform?

1. Health care coverage (insurance)2. Health care quality3. Health care affordability (cost)4. Health care transparency (clearness) 5. Health care accessibility (ease of use) 6. Health promotion and disease

prevention/promoting healthy living

Health Care Coverage

Types of Health Insurance:

Public insurance (Medicaid, SCHP+, Medicare, etc)

Private insurance (employer-based, individual-market)

Issues with health care coverage

Who is eligible for coverage?

Private Insurance: it depends! Lack of transparency in eligibility for private insurance, especially with pre-existing conditions

Public Insurance- Eligibility factors include: Income Single vs. family Age Immigration status and others Health status

Challenges to obtaining coverage: Lack of trust in the program Lack of understanding of the programs Lack of understanding about who and what is covered Systematic challenges (breaking into the system, paperwork required,

time, etc) Don’t qualify (ineligible) Don’t know it’s even available!

Question for discussion

How does health insurance coverage impact you or your community?

Do people have insurance?Are they going without insurance?Do people know about insurance options?Are they confused?What could be better?

Quality of health care

Issues facing quality of care provided: Medical errors Misdiagnoses Poor cost/benefit ratios High costs with not high rates of improved health

outcomes/status Unequal care to populations (uninsured vs insured, SES,

etc) *As a result, stakeholders involved in health care have

made it a priority to reexamine the quality of care provided to Americans

Principles of high quality health care include: Safety Effectiveness Patient-Centeredness Timeliness Efficiency Equity

Quality issues specific to immigrant communities:

Racial and ethnic health disparities

Language access (interpretation and translation)

Cultural competency

Diversity in the health care workforce

Discussion Question

How do these health care quality issues impact your community? Are you seeing this

in your community/family?

Health care costs/affordability

Health care costs increase every year because of: Advances in technology Insurance for doctors (Medical Malpractice) Increases from private market insurance companies Increase costs for physicians and clinical services Increase in costs for prescriptions High costs for early life and end of life care (i.e.

nursing homes home health care) Administrative inefficiencies Inefficient system

How do we keep paying for health care?....we’re trying to figure this out right now!

Health Care Accessibility

Barriers to Access:UninsuredUnderinsured Illiteracy; Total or FunctionalDiscriminationDisability

Health Promotion/ Disease Prevention

Healthy People/Healthy Places: How do we encourage people to adopt these kinds of healthy behaviors?

Healthy Eating – vegetable and fruit consumption, healthy/balanced diet

Physical Activity- walking to work/school, jogging at the park, going to the park, taking the stairs in your apartment)

Not engaging in smoking or drugs; drinking alcohol heavily

Adequate sleep and physical rest Stress reduction/ minimization (exercise, yoga,

deep breathing exercises, support groups)

Question for discussion

What do you think would work in your community to help people engage in

healthy behaviors? (i.e. healthy eating, physical activity, quit smoking, etc).

Government Involvement in Health Care

Provides:Tax Incentives for Health InsuranceHealthcare Coverage, Services & Facilities Medicare: health care for the aged; a federally administered

system of health insurance available to persons aged 65 and over

Medicaid: health care for the needy (those who can't afford it); a federally and state-funded program

State Child Health Insurance Program (SCHIP): cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid.

V.A. Local Government Safety Nets

Regulations:Federal, State, Local i.e. HIPPA (Health Insurance Portability and Accountability Act )

Where do we go from here?

Health care reform Federal Level State Level

Health care issues Colorado legislators are considering Insurance policy reform in the State of Colorado (i.e. Restrict gender

ratings in health insurance, Improve transparency and readability of insurance policies, Standardize EOB forms)

Medicaid Reform Payment and reimbursement reform (i.e. Change reimbursement rates

for providers who accept Medicaid) Establish a dental carve out Address funding mechanisms Increase coverage /participation

Increasing public health/prevention policies (i.e. improve healthy living ) Increase provider workforce Health Information Technology

How may the Federal and State laws impact the immigration population and accessibility to care?

Having a voice!

Why is it important to be involved?

What difference can one person make?

What can I do?