1. Healthcare Through the Ages
Ashley Robertson, MD
Spring Conference
Maine Nurse Practitioner Association
April 2018

2. Presenter Disclosure
Presenter has no conflict of interest of financial relationship to disclose

3. Can anyone tell me when health insurance was first offered?
Personal health insurance purchased by the individual?
Employee Sponsored Healthcare?
How did it develop in other countries?

6. 1940s: Employer-Sponsored Healthcare

7. 1960s: Government-Sponsored Healthcare

8. 1980s: Healthcare of All

9. 2006: Medicare Expanded

10. 2010: Healthcare Reform

11. What was the US healthcare system built to do?
Recruit workers in the era of wage controls during WWII (employer-sponsored health insurance)
Provide health insurance to retirees from the age 65 until the end of life (Medicare)
Cover the uninsured in America (Medicaid)
Treat everyone in emergency conditions even if they are unable to pay (EMTALA)

12. What was the US healthcare system NOT built to do?
Encourage healthy behaviors
Manage chronic disease
Contain costs

13. OECD = Organization for Economic Cooperation and Development

14. Obesity Trends Among US Adults BRFSS, 1985
BRFSS = Behavioral Risk Factor Surveillance System; nation’s system of health related telephone surveys that collect state data about US residents regarding their health related risk behaviors, chronic health conditions, and use of preventative services. Established in 1984 with 15 states.

15. Obesity Trends Among US Adults BRFSS, 1986
BRFSS = Behavioral Risk Factor Surveillance System; nation’s system of health related telephone surveys that collect state data about US residents regarding their health related risk behaviors, chronic health conditions, and use of preventative services. Established in 1984 with 15 states.

16. Obesity Trends Among US Adults BRFSS, 1987
BRFSS = Behavioral Risk Factor Surveillance System; nation’s system of health related telephone surveys that collect state data about US residents regarding their health related risk behaviors, chronic health conditions, and use of preventative services. Established in 1984 with 15 states.

17. Obesity Trends Among US Adults BRFSS, 1988
BRFSS = Behavioral Risk Factor Surveillance System; nation’s system of health related telephone surveys that collect state data about US residents regarding their health related risk behaviors, chronic health conditions, and use of preventative services. Established in 1984 with 15 states.

18. Obesity Trends Among US Adults BRFSS, 1990
BRFSS = Behavioral Risk Factor Surveillance System; nation’s system of health related telephone surveys that collect state data about US residents regarding their health related risk behaviors, chronic health conditions, and use of preventative services. Established in 1984 with 15 states.

19. Obesity Trends Among US Adults BRFSS, 1991
BRFSS = Behavioral Risk Factor Surveillance System; nation’s system of health related telephone surveys that collect state data about US residents regarding their health related risk behaviors, chronic health conditions, and use of preventative services. Established in 1984 with 15 states.

20. Obesity Trends Among US Adults BRFSS, 1993
BRFSS = Behavioral Risk Factor Surveillance System; nation’s system of health related telephone surveys that collect state data about US residents regarding their health related risk behaviors, chronic health conditions, and use of preventative services. Established in 1984 with 15 states.

21. Obesity Trends Among US Adults BRFSS, 1995
BRFSS = Behavioral Risk Factor Surveillance System; nation’s system of health related telephone surveys that collect state data about US residents regarding their health related risk behaviors, chronic health conditions, and use of preventative services. Established in 1984 with 15 states.

22. Obesity Trends Among US Adults BRFSS, 1997
BRFSS = Behavioral Risk Factor Surveillance System; nation’s system of health related telephone surveys that collect state data about US residents regarding their health related risk behaviors, chronic health conditions, and use of preventative services. Established in 1984 with 15 states.

23. Obesity Trends Among US Adults BRFSS, 1998
BRFSS = Behavioral Risk Factor Surveillance System; nation’s system of health related telephone surveys that collect state data about US residents regarding their health related risk behaviors, chronic health conditions, and use of preventative services. Established in 1984 with 15 states.

24. Obesity Trends Among US Adults BRFSS, 1999
BRFSS = Behavioral Risk Factor Surveillance System; nation’s system of health related telephone surveys that collect state data about US residents regarding their health related risk behaviors, chronic health conditions, and use of preventative services. Established in 1984 with 15 states.

25. Obesity Trends Among US Adults BRFSS, 2000
BRFSS = Behavioral Risk Factor Surveillance System; nation’s system of health related telephone surveys that collect state data about US residents regarding their health related risk behaviors, chronic health conditions, and use of preventative services. Established in 1984 with 15 states.

26. Obesity Trends Among US Adults BRFSS, 2001
BRFSS = Behavioral Risk Factor Surveillance System; nation’s system of health related telephone surveys that collect state data about US residents regarding their health related risk behaviors, chronic health conditions, and use of preventative services. Established in 1984 with 15 states.

27. Obesity Trends Among US Adults BRFSS, 2005
BRFSS = Behavioral Risk Factor Surveillance System; nation’s system of health related telephone surveys that collect state data about US residents regarding their health related risk behaviors, chronic health conditions, and use of preventative services. Established in 1984 with 15 states.

28. Obesity Trends Among US Adults BRFSS, 2008
BRFSS = Behavioral Risk Factor Surveillance System; nation’s system of health related telephone surveys that collect state data about US residents regarding their health related risk behaviors, chronic health conditions, and use of preventative services. Established in 1984 with 15 states.

29. Obesity Trends Among US Adults BRFSS: 1990, 2000, 2010

30. Health Consequences of Obesity
Liver and gallbladder disease
Sleep apnea and respiratory problems
Osteoarthritis
Hip replacements
Knee replacements
Gynecological problems (abnormal menses, infertility)
Coronary heart disease
Type 2 diabetes
Cancers:
Endometrial
Breast
Colon
High blood pressure
Hyperlipidemia
Stroke

31. So, What is the Problem?
The problem is not that our healthcare system is broken.
The problem is that we built it to produce a certain set of results, and now we want it to produce entirely different outcomes.
It has to be redesigned.

32. What does the US Healthcare Need? Key Strategic Objectives
Coverage
Insurance Reforms
Delivery System Reforms
Payment Reforms
Transparency
Healthcare IT
Our Nation’s healthcare policy framework needs an overhaul

33. Why is Healthcare Change Inevitable?
No healthcare system in the world could meet the demands we are asking of our system:
Give me the best healthcare in the world
Send the bill to someone else
Don’t bother me about my behaviors

34. Questions