Broken Healthcare Model Flashcards

1
Q

Opinion on Healthcare

A

dependent on your perspective
- if you are not using HC or have good HC, you may think the HC system is good

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2
Q

What is right with the US Healthcare System

A
  • exceptional technology
  • exceptional healthcare facilities
  • rapidly expanding knowledge
  • novel therapeutic entities
  • large and exceptionally trained HCP’s at upper end
  • endless supply of $$$
  • enhanced preventative care
  • engaging patients and understanding their preferences
  • safety through computerized alert systems
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3
Q

What is wrong with the US Healthcare System

A
  • too expensive
  • disconnect between what we pay for and what we value/outcomes achieved
  • compares poorly to other industrialized countries
  • too much money is spend for older patients and end-of-life without clear benefits
  • small percentage of population consume most of resources
  • drug companies can charge whatever they wish
  • lack of transparency with respect to cost
  • access issues
  • lack of care coordination
  • HC lobby is very powerful
  • Public health is underfunded
  • individualism
  • patients are poorly informed misinformed about their healthcare
  • waste
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4
Q

Health Sector Employment

A
  • over the years we have saw tremendous increases in employment
  • during 2020, COVID-19 caused a decline in employment in nonessential occupations
  • we have not fully recovered in LTC and nursing homes
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5
Q

Too Expensive

A

Total National Health Expenditures: $2 trillion

Total National Health Expenditures per capita: $13,493 per capita in 2022

Total National Health Expenditures as % of GDP: 17.3%

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6
Q

Annual Expenditures Growth Rate for Services

A

1970:
- high growth rates in hospitals and physicians
- low growth rates in retail prescription drugs

2020-2022:
- lower growth rates in hospitals and physicians
- higher growth rates in retail prescription drugs due to SPECIALITY DRUGS

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7
Q

Contributions to Total National Health Expenditures by Service

A
  1. Hospitals
  2. Other
  3. Physicians & Clinics
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8
Q

Financial Toxicity

A
  • due to very high medical costs, financial problems are resulting from bills and debt
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9
Q

What percentage of individuals are contacted by collection agency for unpaid bills?

A

14%

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10
Q

Disconnect between what we pay for and what we value and outcomes achieved

A
  • we are paying more to do more
  • life expectancy, infant mortality, and maternal mortality do not measure up to expenditures
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11
Q

Life Expectancy in US vs Comparable Countries & Spendings

A

Other countries:
- 82.4
- $6,000

US:
- 76.1
- $12, 318

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12
Q

Healthcare System Performance Rankings

A
  • the United States ranked 11/11 in all areas except for the care process (2/11)
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13
Q

What are other top-performing countries doing?

A
  • universal coverage and remove cost barriers
  • invest in primary care systems to ensure high value care is equitable
  • reduce administrative barriers
  • invest in social services for children & working adults
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14
Q

Healthcare Spending Trajectories of Medicare in last years of life

A

Different patterns:
- high persistent
- moderate persistent
- progressive
- late rise

ALL PATTERNS COST DRASTICALLY GO UP WITHIN LAST COUPLE MONTHS OF LIFE

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15
Q

Share of Total Population vs Total Health Spending

A
  • the majority of the population is 45 years and less
  • the majority of the spending is older adults aged 50 and above
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16
Q

Total Health Spending by Age and Sex

A
  • 65+ age range spends the most on HC
  • no dramatic differences between female and male
  • you see a small spike in women during the 19-34 due to pregnancy
17
Q

Share of Total Health Spending

A
  • bottom 50% of population consumes nearly 0$
  • top 1% consumes nearly 25% of HC spending

FOCUS MORE ON THE HIGH SPENDERS TO SAVE MONEY

18
Q

Rx Drug Spending over the years for Humira

A
  • in 2003: 522$
  • in 2021: 2,984$

IT IS THE SAME EXACT DRUG

19
Q

Revenue Growth of Humira

A
  • baseline revenue has stayed stable
  • volume (demand) driven revenue has only increased by a little
  • price driven revenue is what is increasing the costs of drugs

BECAUSE THEY CAN

20
Q

Brand and Speciality Drugs drive high costs in US

A
  • 90% of all dispensed prescriptions are generic but only represents 20% of drug spending
21
Q

Access Issues Include:

A
  • poor and rural
  • geographical locations (pharmacy deserts)
  • # of PCP per 10K patients
  • costs of annual health insurance premiums
22
Q

Geography (Access Issues)

A

people living in West North Central have longest travel times to nearest hospital

23
Q

Worst Care vs Best

A
  • looks at # of PCP per patient + insurance premiums

WORST CARE IN THE SOUTH

24
Q

Equity Issues within HC

A
  • adults with below average income have poorer access to healthcare, less timely care, and less engagement with providers
  • the larger the employer, the better access to HC and coverage
25
Too Few PCPs
- PCP are poorly distributed and poorly reimbursed
26
Lack of Care Coordination
- patients are sometimes responsible for care coordination - if patients are knowledgeable or have enough time, patients need care coordinators - we can save money if we hire HC coordinators
27
Healthcare Lobby is Powerful
- politics drives policy drives HC - politicians are suppose to be lobbyist for patients * limiting and dictating how HCP practice * public health is underfunded * pediatrics, women's health, emergency medication
28
Local and Federal Expenditures on Public Health
- predominantly funded by the state and local funds with minimal funding from federal funds * federal govt only funded in 2020 due to COVID-19
29
Minimal Focus on Preventable Deaths
1. Drug Overdose 2. Alcohol Induced 3. Suicide WILL OF PAYERS TO PAY FOR TREATMENTS ARE NOT THERE FOR PREVENTABLE MEASURES
30
What has contributed to poorly informed or misinformed patients?
Internet & Social Media
31
Managed Care Organizations Downside
- focus on decreasing utilization of health sources and certain medications - decision makers are not even associated with patients care
32
What is the model of providing healthcare in the United States
- having a job with healthcare benefits - only industrialized country without universal coverage
33
Healthcare Costs for Employers and Employees
- HC costs have been increasing for both employers and employees - employers have shifted more costs to employees through deductibles and copays
34
Waste of HC Resources
- unnecessary care (duplicated therapy/tests or therapy that we know will not work) - administrative duties (PA) - fraud - care outside of standards & guidelines
35
Roles of Pharmacists in Remodeling Healthcare
- MTM services for complex patients - educate patients on preventative health services like nutrition, exercise, and smoking cessation - help patients navigate complex HC system - educate patients on unnecessary care and medications - ADVOCATE FOR TRANSPARENCY
36
How should we measure healthcare?
Quality Access Efficiency Equity Healthy Lives