Health Policy in New York: The Landscape in 2009 James R. Tallon, Jr. President United Hospital Fund December 9, 2008

International Comparison of Spending on Health: 1980–2006 Average spending on health per capita ($US PPP) Total expenditures on health as percent of GDP 2

Commonwealth Fund National Ranking on Quality 3 1. United Kingdom 2. Germany(tie) New Zealand 4.Australia 5.United States 6.Canada

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Projected deficit in billions New York State Budget Forecast 6

7 New York State Expenditures: General Fund $50.4 billion projected in SFY $10.7 billion $16.1 billion

8 Medicaid Spending in New York by Source of Funds $44.9 billion projected in SFY $22.4 billion $4.6 billion

Projected Medicaid Spending Growth in New York Medical inflation : + 3 % Intensity of service use : + 4 % Per capita costs : + 7 % Enrollment (not weighted) : + 5 % Enrollment (cost-adjusted) : + 2 % All-funds spending : + 9 % State costs due to local cap: + 3 % State-funds spending : + 12 % 9

10  Leadership change  Deep, long-term budget crisis  Continuing policy debate  Need for federal support The Albany Transition

11  Affordable health insurance for all  Focus on engaging patients  Population / community focus on health and disease prevention  Primary care emphasis, including workforce  Integrated, coordinated care An Emerging Paradigm (?)

12  Realigned provider payments  Quality measurement and improvement  Health information technology  Strengthened leadership structure An Emerging Paradigm (?) Cont.

13  Where do states fit in federal policy?  Can New York be New York?  What is the private-sector’s role?  Who can manage change? Four Key Questions