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PHRM 849 > Broken Healthcare Model > Flashcards

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
Q

Too Few PCPs

A
  • PCP are poorly distributed and poorly reimbursed
26
Q

Lack of Care Coordination

A
  • 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
Q

Healthcare Lobby is Powerful

A
  • 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
Q

Local and Federal Expenditures on Public Health

A
  • 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
Q

Minimal Focus on Preventable Deaths

A
  1. Drug Overdose
  2. Alcohol Induced
  3. Suicide

WILL OF PAYERS TO PAY FOR TREATMENTS ARE NOT THERE FOR PREVENTABLE MEASURES

30
Q

What has contributed to poorly informed or misinformed patients?

A

Internet & Social Media

31
Q

Managed Care Organizations Downside

A
  • focus on decreasing utilization of health sources and certain medications
  • decision makers are not even associated with patients care
32
Q

What is the model of providing healthcare in the United States

A
  • having a job with healthcare benefits
  • only industrialized country without universal coverage
33
Q

Healthcare Costs for Employers and Employees

A
  • HC costs have been increasing for both employers and employees
  • employers have shifted more costs to employees through deductibles and copays
34
Q

Waste of HC Resources

A
  • unnecessary care (duplicated therapy/tests or therapy that we know will not work)
  • administrative duties (PA)
  • fraud
  • care outside of standards & guidelines
35
Q

Roles of Pharmacists in Remodeling Healthcare

A
  • 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
Q

How should we measure healthcare?

A

Quality
Access
Efficiency
Equity
Healthy Lives

PHRM 849 (25 decks)

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