Broken Healthcare Model Flashcards
Opinion on Healthcare
dependent on your perspective
- if you are not using HC or have good HC, you may think the HC system is good
What is right with the US Healthcare System
- 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
What is wrong with the US Healthcare System
- 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
Health Sector Employment
- 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
Too Expensive
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%
Annual Expenditures Growth Rate for Services
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
Contributions to Total National Health Expenditures by Service
- Hospitals
- Other
- Physicians & Clinics
Financial Toxicity
- due to very high medical costs, financial problems are resulting from bills and debt
What percentage of individuals are contacted by collection agency for unpaid bills?
14%
Disconnect between what we pay for and what we value and outcomes achieved
- we are paying more to do more
- life expectancy, infant mortality, and maternal mortality do not measure up to expenditures
Life Expectancy in US vs Comparable Countries & Spendings
Other countries:
- 82.4
- $6,000
US:
- 76.1
- $12, 318
Healthcare System Performance Rankings
- the United States ranked 11/11 in all areas except for the care process (2/11)
What are other top-performing countries doing?
- universal coverage and remove cost barriers
- invest in primary care systems to ensure high value care is equitable
- reduce administrative barriers
- invest in social services for children & working adults
Healthcare Spending Trajectories of Medicare in last years of life
Different patterns:
- high persistent
- moderate persistent
- progressive
- late rise
ALL PATTERNS COST DRASTICALLY GO UP WITHIN LAST COUPLE MONTHS OF LIFE
Share of Total Population vs Total Health Spending
- the majority of the population is 45 years and less
- the majority of the spending is older adults aged 50 and above
Total Health Spending by Age and Sex
- 65+ age range spends the most on HC
- no dramatic differences between female and male
- you see a small spike in women during the 19-34 due to pregnancy
Share of Total Health Spending
- bottom 50% of population consumes nearly 0$
- top 1% consumes nearly 25% of HC spending
FOCUS MORE ON THE HIGH SPENDERS TO SAVE MONEY
Rx Drug Spending over the years for Humira
- in 2003: 522$
- in 2021: 2,984$
IT IS THE SAME EXACT DRUG
Revenue Growth of Humira
- 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
Brand and Speciality Drugs drive high costs in US
- 90% of all dispensed prescriptions are generic but only represents 20% of drug spending
Access Issues Include:
- poor and rural
- geographical locations (pharmacy deserts)
- # of PCP per 10K patients
- costs of annual health insurance premiums
Geography (Access Issues)
people living in West North Central have longest travel times to nearest hospital
Worst Care vs Best
- looks at # of PCP per patient + insurance premiums
WORST CARE IN THE SOUTH
Equity Issues within HC
- 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
Too Few PCPs
- PCP are poorly distributed and poorly reimbursed
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
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
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
Minimal Focus on Preventable Deaths
- Drug Overdose
- Alcohol Induced
- Suicide
WILL OF PAYERS TO PAY FOR TREATMENTS ARE NOT THERE FOR PREVENTABLE MEASURES
What has contributed to poorly informed or misinformed patients?
Internet & Social Media
Managed Care Organizations Downside
- focus on decreasing utilization of health sources and certain medications
- decision makers are not even associated with patients care
What is the model of providing healthcare in the United States
- having a job with healthcare benefits
- only industrialized country without universal coverage
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
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
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
How should we measure healthcare?
Quality
Access
Efficiency
Equity
Healthy Lives
