1. 1 Common Challenges US and Canadian Health Care CSG – ERC August 9, 2011

2. 2 US Health System Accident of History Early USVeteran’s support 1930’sVeteran’s Administration 1940’sEmployer Sponsored Insurance 1965Medicare – over 65 Medicaid – low income 1997Children’s Health Insurance (CHIP) 2010Affordable Care Act

3. 3 Our Hodgepodge System Costs more than other OECD countries Doesn’t cover everybody Far from seamless Dismantling 80 years of a piecemeal policy approach tremendous challenge

4. 4 International Comparison of Spending on Health, 1980–2008 Average spending on health per capita ($US PPP) Total expenditures on health as percent of GDP Source: OECD Health Data 2010 (June 2010).

5. 5 Life Expectancy at Birth, 2007 * 2006 ** 2005 Source: OECD Health Data 2009 (June 2009). Years

6. 6 QUALITY COST ACCESS Balancing Needs and Viewpoints

7. 7 Let’s Look at Ourselves Canada 34 million 68% 15 – 64 16% over 65 81 – life expectancy @birth 81% population urban Source CIA World Factbook United States 313 million 67% 15 – 64 13% over 65 78 – life expectancy @ birth 82% population urban

8. 8 Out-of-Pocket Spending of $1,000 or More in the Past Year, by Income Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.— insurance status. * Indicates significant within-country differences with below-average income (p < 0.05). Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries. (Adjusted) percent

9. 9 Challenges Changing demographics Cost Workforce Improving delivery of care

10. 10 Changing demographics Ethnicity Age Languages spoken Generations Attracting workforce to deliver care to changing demographics

11. 11 Cost CHALLENGES Aging Boomers will drive volume regardless of financing approach “80/20 rule” – lifestyle choices and chronic conditions Fragmented care Inefficient care – duplication etc.

12. 12 Workforce AAMC projects 91,500 shortage of physicians by 2020; nearly half primary care Health professionals are aging too! Supply and distribution problems BLS March 2011 healthcare sector added 37,000 new jobs – largest increase in any employment sector

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14. 14 Looking Ahead - US Patient Centered Medical Home –Payment Reform –Scope of Practice Accountable Care Organizations –Team approach – best care, less spending –Evidence based medicine Technology –health information exchanges and electronic medical records Incentives – Loan Repayment

15. 15 CONTACT INFORMATION Paula K. Roy Executive Director Delaware Health Care Commission Margaret O’Neil Building 410 Federal St. Suite 7 Dover, DE 19901 302-739-2730 302-739-6927 fax Paula.roy@state.de.us www.dhcc.delaware.gov