1. Healthcare USA
Medical Care

2. Define Health
WHO- state of complete physical, mental and social well-being, not merely the absence of disease
IOM- a state of well-being and the capability to function in the face of changing circumstances(social and personal resources and physical capabilities)
SAEM- state of physical and mental well-being that facilitates the achievement of individual and societal goals (Society for Academic Emergency Medicine)

3. Indicators of Health Infant Mortality Rate Life Expectancy
Rates of Disease
Causes of Death and Disability

4. Define Healthcare
The prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical and allied health professions. (Medical Dictionary)
WHO- “to ensure that all people obtain the health services they need without suffering financial hardship when paying for them.”

5. Define Health Care
A healthcare system is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.
The enrolled population enters into a contract with the organization, agreeing to pay, or have paid on their behalf, a fixed sum, in return for which the HMO makes available the health care personnel, facilities, and services that the population may require.
Implicitly, nations must design and develop health systems in accordance with their needs and resources, although virtually all health systems have primary healthcare and public health measures.
White F (2015). "Primary health care and public health: foundations of universal health systems". Med Princ Pract. 24: 103–116. doi: /

6. Indicators for health care
% GDP
% Government (Public) Expense
Per capita
Administration Costs
Resources-
Pharmaceutical,
Physicians and Nurses and other providers
Medical Technology
Hospitals, clinics, rehab centers, nursing homes

7. Where USA ranks in World
World Health Report 2000
“A healthcare system should strive to achieve the highest possible average level of health with the fewest disparities among individuals and groups”
USA ranked 37 out of 191 countries
USA ranked #1 in spending

8. Health Care Spending Per Capita by OECD Country, 1960-1999
Table 1.23
Health Care Spending Per Capita by OECD Country,
U.S. spending is significantly higher than other OECD countries.
Median: $ $ $ $1,270 $1,798
*Expenditures in U.S. dollars using purchasing power parity rates.
**For some years, no data was available.
***1998 data was used because 1999 was not available.
Note: The data is arrayed by expenditure levels for The medians include all OECD countries.
Source: OECD Health Data 2002.

9. Total Health Expenditure per Capita, U.S. and Selected Countries, 2008
Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: /data en (Accessed on 14 February 2011). Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted.

11. Percent of GDP Spent on Health Care by OECD Country, 1960-1999
Table 1.25
Percent of GDP Spent on Health Care by OECD Country,
The U.S. has had a higher share of GDP spent on health than the OECD median for the past four decades.
Median: % % % % %
*For some years, no data was available.
**1997 data was used because 1999 was not available.
Note: The data is arrayed by spending growth from 1990 to The medians include all OECD countries.
Source: OECD Health Data 2002.

12. National Health Spending by Source of Funds by OECD Country, 2000
Table 1.27
National Health Spending by Source of Funds by OECD Country, 2000
Source of funding varies significantly by country. For instance, out-of-pocket spending ranges from 10% to 44% of health spending with the U.S. at about the average.
Source: OECD Health Data nd ed.

13. Where USA ranks in OECD World
USA ranked lowest in health indicators:
Infant mortality
Low birth weight percentages
Years of potential life lost

14. Where USA ranks in World
After WWII Americans were known as the tallest people…now they are known as the fattest.
CIA - The World Factbook - Guide to Country Profiles

15. Male and Female Life Expectancy at Birth by OECD Country, 1960-1999
Table 1.34
Male and Female Life Expectancy at Birth by OECD Country,
Male
Female
Median =
Median =
Note: Data are arrayed by male life expectancy; countries are kept together. The medians include all OECD countries.
Source: OECD Health Data 2002.

17. USA compared to other countries

19. Infant Mortality Rate, USA by Race http://mchb. hrsa

21. The USA spends more money on healthcare But does not have the best health indicators!

22. History of USA Healthcare System
Golden Age – 1950’s – 1980’s
Fee for service: doctors, hospitals and clinics provide services and bill insurance companies.
Providers are rewarded for providing more and more services
Problem of unnecessary treatments and waste

23. History
After Healthcare costs skyrocketed, 1980’s – 1990’s, “managed care” philosophy put on the brakes for spending
HMO-Health Maintenance Org.
MCO- Managed Care Organizations
PPO- Preferred Provider Org.

24. US Healthcare (2008)
Employers provide 60% of health insurance (benefits package)
Emloyees may pay premiums or deductibles and co-pays
Doctors, hospitals, clinics and providers are all privately owned.

25. Health Coverage, total population
Employer 54%  
Individual 5%  
Medicaid 13%  
Medicare 12%  
Other Public 1%  
Uninsured 16% 

26. US Healthcare (2008) 45 million uninsured, 8.5 million children
Working poor, no insurance
1/4 employers do not provide insurance
Unemployed
Uninsurable
18,000 people die each year because they lack insurance (example: women with breast cancer 50% more likely to die without insurance)

28. Putting Off Care Because of Cost
In the past 12 months, have you or another family member living in your household… because of the COST, or not?
Percent saying “yes”
Relied on home remedies or over the counter drugs instead of seeing a doctor
Skipped dental care or checkups
Put off or postponed getting health care you needed
Not filled a prescription for a medicine
Skipped recommended medical test or treatment
Cut pills in half or skipped doses of medicine
Had problems getting mental health care
Did ANY of the above
Source: Kaiser Family Foundation Health Tracking Poll (conducted November 5-12, 2009)

29. Current US Healthcare Government is involved only partially
Fills the gap where private care stops
HHS, FDA, CDC, and many regulatory agencies--few direct services
State and County Health Departments
Vaccines, Infectious diseases, Prenatal care
Some hospital and clinic services especially for mental health

30. Government Insurance :Medicare / Medicaid
Center for Medicare and Medicaid (CMS)
Established in 1965 for elderly and low income
Medicare: for citizens over 65
Federal hospital and doctor insurance
Some premiums due
Does not cover prescription drugs (until 2006 under the Medicare Modernization Act)
Medicaid
Cost covered by state and federal govt
States determine extent of benefits
Eligibility determined by income
In Oregon - Oregon Health Plan

31. Costs
14% of USA GDP per year (includes all health expenditures, public and private)
45% govt., 55% private
17% of all government expenditures ($2.56 trillion)
33% is Medicare and Medicaid

32. USA Revenues and Expenditures
Year
Revenues
Expenditures
2006
2,409
2,665
2008
2,524
2,978
2009
1,914
3,615
2011
2,465
3,649
2012
2,449
3,538

34. Institute of Medicine 2004 Report
“ The United State should adopt universal health coverage by 2010 to avoid needless deaths and substantial monetary costs to society”
Economic costs for premature deaths
Poorer health among the poor costs more in future
Hospitals uncompensated for care, close

35. Institute of Medicine 2004 Report
Recommendations
Single payer system administered by the government
Combination government and employers to provide insurance coverage
Tax credits for individuals to purchase insurance

36. Resources Institute for Healthcare Improvement http://www.ihi.org/ihi
Health and Humans Services: Hospital Compare
Health Resources and Services
Health Information: