1. The Employer-based Health Care System: Shifting Responsibilities 2007 National Health Policy Conference Eduardo Sanchez, M.D., M.P.H. Director, Institute for Health Policy School of Public Health University of Texas Health Science Center at Houston February 12, 2007

2. Employer-financed Health Care and the Uninsured

3. –Healthcare premiums are growing more than 3 times faster than workers wages and 2.5 times faster than the inflation rate –Percentage of employers providing health benefits 200069% 200560% –State of Texas employee health care costs up 53% since 2000 The Rising Spiral of Health-Care Costs 2005 Kaiser Foundation Survey

4. Employer-Sponsored Insurance Coverage 61% have insurance through their employer in the United States In Texas, only 53% have insurance through their employer 43% of companies with 50 or less employees provide insurance nationally In Texas, only 31% of companies with 50 or less employees provide insurance Texas Hospital Association, April 2006

5. Government-Sponsored Insurance Coverage in Texas Medicaid CHIP County-based medical programs Health insurance for employees/retirees Texas Hospital Association, April 2006

6. Spiral of Health Cost Increases with High Numbers of Uninsured Uninsured utilize higher than necessary levels of care More uninsured More employers drop coverage because of high premiums Insurance companies Raise premiums for insured Increased charges to paying customers Higher uncompensated costs

8. For More Information Task Force Website http://www.utsystem.edu/hea /taskforce/homepage.htm Report Website http://www.coderedtexas.org

9. How can the spiral be interrupted? Reduce the number of uninsured –Increase numbers of eligible and enrolled in Medicaid/CHIP/state or local government programs –Make insurance more accessible/affordable Individually purchased Employer provided –Necessary but not sufficient

10. The Healthcare Equation is Out of Balance Demand Older Heavier More Sedentary Un & Underinsured Health Illiterate Supply Increasing Access Increasing Workforce System Redesign Improving Quality of Care Improving Technology Improving Meds Demand Reduction Is Imperative

11. Supply Increasing Access Increasing Workforce System Redesign Improving Quality of Care Improving Technology Improving Meds Demand Reduction Is Imperative Health Promotion Health literacy initiativesHealth literacy initiatives Healthier lifestylesHealthier lifestyles Access to care (clinical preventive services)Access to care (clinical preventive services) The Healthcare Equation is Out of Balance

12. How can the spiral be interrupted? Improve population health –Traditional and chronic disease-focused public health –School-based health education and management –Worker health promotion (worksite wellness)

13. How can the spiral be interrupted? Transform the health care delivery system –Invest in and connect to public health –Primary-care centered health system

14. Patient Centered Medical Home (mental/dental/medical) 1.Easy access 2.Continuity of care 3.Comprehensive care 4.Coordination of all care (Includes disease management ) Tobacco Prevention And Cessation Comprehensive School Heath Education Worker and Worksite Wellness Specialty Care Diagnostic Testing Hospital Based Care Inpatient Care Emergency and trauma care Primary-care Centered Health System Public Health Primary Care Specialty/Tertiary Care Medical Care Concept = Optimal Communication (Integrated Virtual System) Including best use of health informational technology

15. Two questions to ponder Who pays and how? –Financing What are we buying? –Population health