Interesting U.S. Health Care Factoids In Which People Might Be Interested

by Justitia Themis 3 Replies latest jw friends

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  Justitia Themis
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  Justitia Themis

  a. Major Drivers of US Health Care Increases, Txt. 186 (Law of Health Care Organization and Finance, 6th Ed.)

  i. National wealth

  1. In wealthy countries, % spent on HC is linearly proportional to their GDP=more wealthy/more HC dollars spent.

  2. BUT, US (2001) spent 43% MORE than the formula.

  ii. Population aging

  1. Age affects HC costs, but US has one of the youngest populations for a developed = medicine not an exact science but

  a. Patients with non-surgical conditions more likely to hospitalized in regions with more hospital beds

  b. Medicare enrollees are seen by cardiologists much more often in areas with more cardiologists.

  c. Yikes!=mortality rates seem to be higher in those who get more care; more care not always better. Implications of Regional Variations in Medicare Spending: Part 2: Health Outcomes and Satisfactions With Care, 138 Annals of Int. Med. 288, 291-92 (2003>

  iii. Market structure

  1. Concentrated in geographic areas

  2. Market concentration can facilitate collusive attempts to raise prices

  3. Pushback from powerful hospitals/provider groups

  iv. Administrative costs

  1. OMG! Yeah ACA! We pay more proportionately for administrative costs than ANY other nation in the world! $1059 p/p in 1999, compared with $307 p/p in Canada. Why?

  a. Private insurance costs more; public systems don’t have these costs:

  i. Marketing, underwriting, monitoring, billing

  2. Medicare spends 2 cents per dollar on administrative costs; private spends 25 cents per dollar for small market group, and 5.5 cents per dollar on large market groups.

  3. Costs of Lack of Uniformity

  a. Doctors must use tons of different billings forms/rules

  b. Public-one billing form, one payer.

  v. Malpractice

  1. Insurance not a big deal; premiums less than 1%

  2. Defensive medicine greater concern, but extent to which it contributes to HC costs not reliable measured yet. GAO, Medical Malpractice: Implications of Rising Premiums on Access to Health Care, GAO-03-836 (2003); Chpt. 1.

  vi. Changing Nature of Disease

  1. US disease changing from serious disease/functional limitations to metabolic disorders. Impact?

  a. Higher costs to treat people with chronic disease is self-limiting; they die sooner. So yes, spend more to care, but over a shorter period.

  b. Obese people (diabetes, hypetension) cost more to treat, and they live as long as normal weight persons. Add to costs of the kidney/heart transplants they will need in the future—since the US is getting so fat—we are screwed.

  vii. Treating “hopeless cases”

  1. No evidence we spend an excess amount providing heroic interventions to near death people.

  viii. Higher prices v. Consumption

  1. We spend more, but aren’t getting more.

  a. Average doctor’s visits per year

  i. US=5.8

  ii. Canada=6.4

  iii. England=5.4

  b. Average days per year in hospital

  i. US=.7

  ii. Germany=1.9

  iii. England=.9

  2. We just spend dramatically more per unit of health care.

  a. Incidental=also pay lots more for our drugs; even the exact SAME drug.

  3. Implications?

  a. American’s do NOT get more or better health care in the US. We just pay a shit-load for what we get. Therefore, we CAN dramatically reduce HC costs without losing HC access/coverage.

  4. How managed care companies affect the market

  a. Pay exorbitant salaries to executives; hire tons of people to monitor and restrict access to care/procedures. Winners

  b. Demand deeper discounts from providers. Losers

  c. Therefore, reduce HC costs NOT by providing better medical care, but by driving down provider’s incomes and patients access to care.

  i. Patients/providers=losers; executives=winners

  ix. Technology

  1. Big recent driver; remove effect of inflation economy-wide, more than half o the 6.8% per capita real health spending growth in 2002 was accounted for explicitly by technology.
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  MrFreeze

  Might want to put that in a format that is easier to read.

  Edit: Never mind. I see you have just done that.
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  jamesmahon

  Some interesting points JT. I could debate some of them but to me it seems that the whole healthcare debate in the USA boilds down to this:

  • Am I happy paying for treating someone else's ill health?

  However, those that are insured already - as with all insurance - do pay for the misfortune as others. So I would suggest that the question really boils down to

  • Am I happy paying for treating someone else's ill health who is too poor to insure themselves?

  Whichever way it is spun this really is the core of the matter. Those that are rich enough for insurance are willing to pool their risk with other Americans. Just those American's that are rich enough to also pay as much as them. Why is it such a big leap to take to accept that risk could be pooled with all citizens regardless of their income? I guess it is a big leap if you believe the poor are poor because they choose to be poor and if they just worked harder they could afford insurance to.

  I wonder if the argument had been shaped around access to healthcare for all US citizens being based on need as something that as a nation every citizen could be proud of it could have been a unifying policy rather than how it has transpired.

  Never mind.