1. The US Healthcare System Lecture 1 Tracey Lynn Koehlmoos, PhD, MHA HSCI 609 Comparative International Health Systems

2. Course Organization US Healthcare System, Roemer Model (Quiz #1) Canada, Europe Asia, Pacific Rim (Quiz #2) Developing Nations

3. Course Requirements Read assigned chapters Watch video lectures Additional Readings and Chat Sessions –Attend three out of four Discussion Board postings –Introduction, 4 additional postings Country Health Services Project –Apply Roemer Model –Assess a population/country of your choice

4. US Healthcare System Complex, fragmented, in constant flux 16% of Gross Domestic Product (2005) $1.3 trillion Per capita: $4,673 (2000) 16-20% no access at any given time 80:20 paradox: 80% of services used by 20% of the population Tremendous variation in quality and access based on state and rural differences

5. High Price/Low Payoff? Most technologically advanced in world > $28 Billion for Biomedical Research (2006) US lags behind other OECD nations for outcomes: (2000 data) –Life expectancy: 73.9 Male/ 79,4 Female –Infant mortality: 7.2 per 1000

6. Why? Demographic factors: diverse population with varying beliefs; racial and ethnic disparities; aging population Systemic Factor: Curative focus rather than prevention and promotion focus Insurance is access: linked to age, poverty and employment (historical development) 30% of Medicare and Medicaid expenditures on patients in last year of life

7. Core Values of US Healthcare System ACCESS QUALITYCOST

8. Major Policy Initiatives Social Security Act (1965)—Access –Medicare: Elderly, ESRD, disabilities –Medicaid: State/Fed; Low Income & disabled, HIV, pregnant, BC/CC, children, blind HMO Act 1973—Cost Containment –Reduce costs to employer, employee –Slow start, by 2002 managed care covers 92% of employee sponsored US population Tax Equity & Fiscal Responsibility Act (1982)— Cost Containment and Quality –Prospective Payment for Medicare (DRGs) –Peer Review Organizations

9. Issues and Trends The Rise and Fall of Managed Care Aging of the Baby Boomer generation Medicare Part D Emergence of Allied Health professionals Nursing Crisis Fragmented Long Term Care Costs continue to skyrocket

10. More facts… Healthcare spending is the US government’s second largest expenditure The health services workforce is the largest segment of the population, 11% If change does not take place in the US healthcare system; by 2065 we will spend 25% of our GDP on health services

11. Where do we go from here? Next lecture: more US healthcare system details using the Roemer Model Be sure to introduce yourself via the discussion board Read the chapters Watch the lectures Take the quiz Let me know if you have any questions