1. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Ch 13 Health Care Trends and Forecasts

2. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Health Care Spending World-wide 13-2

3. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. American Health Care Costs 13-3

4. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Factors Affecting Health Care Costs Application of more advanced and more types of technology Growth in the population of older adults Emphasis on specialty medicine Increasing numbers of uninsured and underinsured Labor intensity of health care services Reimbursement system incentives 13-4

5. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Effect of Increasing Uninsured People Uninsured and underinsured people make more visits to emergency rooms than those who have health insurance Uninsured individuals do not see physicians regularly and are, therefore, more likely to develop medical conditions that lead to costly complications or hospitalizations. 13-5

6. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. AHRQ Tracking Health Care Quality The Agency for Healthcare Research and Quality is the lead federal agency responsible for tracking and improving the quality, safety, efficiency, and effectiveness of health care for Americans. 13-6

7. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. National Healthcare Quality Report Health care quality and access are not as good as they could be, especially for minority and low-income people. While quality is improving, there are still too many disparities in access and health care quality. 13-7

8. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. National Healthcare Quality Report Uneven progress being made in eight national priority areas: –Two are improving in quality: (1) palliative and end-of-life care and (2) patient and family engagement. –Three are lagging: (3) population health, (4) safety, and (5) access. –Three require more data to assess: (6) care coordination, (7) overuse, and (8) health system infrastructure. 13-8

9. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. NHQR High Priority Areas Cancer screening Diabetes management Health care services in the central United States Services in inner cities and rural areas Disparities in preventative services and access to care 13-9

10. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Special Concern for the Future Securing benefits Monitoring and organizing increasing numbers of managed care organizations, insurers, intermediaries and providers Including consumers in health care decision making Determining responsibility for medical management Improving health behaviors of Americans 13-10

11. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Medical Technology Affecting Care Rational drug design Continuing advancement in imaging equipment and techniques Minimally invasive surgery Genetic mapping and testing Gene therapy New and improved vaccines 13-11

12. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Medical Technology Affecting Care Artificial blood Xenotransplantation Use of stem cells Personalized medicine 13-12

13. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Question Tell whether the following statement is true or false. An example of using rational drug design is combining drugs to combat HIV/AIDS into an AIDS cocktail. True False 13-13

14. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Answer False Combining drugs to combat HIV/AIDS into an AIDS cocktail is drug therapy. Rational drug design uses computers to develop new drugs by looking at the molecular structure and chemical composition of target cells and creating substances that will bind to certain molecules, affecting their function inside the body. 13-14

15. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Genetic Mapping and Testing Pharmacogenomics –The science that defines how individuals are genetically programmed to respond to drugs Genometrics –The science of determining how genes cause the expression of certain traits in individuals 13-15

16. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Genetic Mapping and Testing Epignetics –The study of changes in gene activity that do not involve alterations to the genetic code, but are still passed down to at least one successive generation 13-16

17. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Gene Therapy A normal gene may be inserted into a nonspecific location within the genome to replace a nonfunctional gene A normal gene could be substituted for an abnormal gene through an exchange of sections of chromosomes during meiosis 13-17

18. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Gene Therapy (cont.) The abnormal gene could be repaired through selective reverse mutation, which returns the gene to its normal function The regulation (the degree to which a gene is turned on or off) of a particular gene could be altered 13-18

19. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Health Security Act of 1993 It guaranteed health insurance benefits to all Americans, with no lifetime limits on coverage. It provided a comprehensive package of medical services delivered in hospitals, clinics, professional offices, and other sites. 13-19

20. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Health Security Act of 1993 (cont.) It provided for one uniform, comprehensive benefit package that would replace hundreds of different insurance products on the market. Health insurance premiums would pay the cost of the new system, but enforceable caps would be placed on the rate of increase in premium prices. 13-20

21. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. PPACA Provisions Effective 2010 13-21

22. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. PPACA Provisions 2014 - 2018 13-22

23. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. SCHIP State Children’s Health Initiative Program (SCHIP) –A program enacted by the Balanced Budget Act of 1997 to help low-income children under 19 who are not covered by Medicaid. 13-23