Healthcare, health policy, cognitive science. , and the path to Universal Healthcare..
McKinsey: What Matters: Way too much for way too little
The title says it all. A great review of the American health care non-system.
Goes over administrative waste (83 cents of premium dollars go to actual health care at most in PHI market), outcomes, costs and prices, administrative burden, practice variation, and rationing (QALY’s CER).
Some good response letters as well.
KaiserEDU’s tutorials are multimedia presentations on health policy issues, research methodology or the workings of government.
Here are a few to get started (I haven’t yet, but put them here for reference and eventual use!)
Health policy experts provide overviews of current topics in health policy. Watch and download slides from these and other tutorials:
The Public and Health Care Reform
A Primer on Tax Subsides for Health Care
Expanding Health Coverage to the Uninsured
They also have Compendiums:
These modules include background summaries along with links to academic literature, policy research and data sets on current health policy issues, such as:
U.S. Health Care Costs
Health Information Technology
Addressing the Nursing Shortage
The Uninsured
International Health Systems
The Globalist Global Health — What Obama Can Learn from European Health Care (Part I):
“Imagine a place where doctors still do house calls. When I was visiting my friend Meredith, living in the small rural town of Lautrec about an hour’s drive outside Toulouse, France, one day she was stung badly by a wasp, causing a sizable and painful swelling on her hand.
“She called her doctor, and to my great surprise within 15 minutes he had shown up at her door — the famous French doctor’s house call. I couldn’t get over it. “House calls in the United States went out when Eisenhower was president,” I told her, shaking my head.”
Part Two of this article is here.
“The first overriding difference between U.S. and European healthcare systems is one of philosophy. The various European healthcare systems put people and their health before profits — la santé d’abord, “health comes first,” as the French are fond of saying.
“It is the difference between health care run mostly as a non-profit venture with the goal of keeping people healthy and productive — or running it as a for-profit commercial enterprise. “
And this section is well said:
Unlike single-payer Britain or Sweden, other nations like France, Germany, Switzerland and Belgium have figured out a third way, a hybrid with private insurance companies, short waiting lists for treatment and individual choice of doctors (most of whom are in private practice).
This third-way hybrid is based on the principle of “shared responsibility” between workers, employers and the government, all contributing their fair share to guarantee universal coverage.
Participation for individuals is mandatory, not optional, just as it is mandatory to have a driver’s license to drive a car.
These healthcare plans are similar to what Massachusetts recently enacted — but with two essential differences. First, in France and Germany, the private insurance companies are non-profits. Doctors, nurses and healthcare professionals are paid well, but you don’t have corporate healthcare CEOs making hundreds of millions of dollars. Generally speaking, the profit motive has been wrung out of the system.
The second key difference is in the area of cost controls. In France and Germany, fees for services are negotiated between representatives of the healthcare professions, the government, patient consumer representatives and the private non-profit insurance companies.
These are a nice pair of articles to send to people who need a basic primer on what “socialized medicine” really is, rather than what the Right wants you to think it is.
Cheers,
Just a link to OECD data so I can get back to it easily…
“The Remuneration of General Practitioners and Specialists in 14 OECD Countries: What are the Factors Influencing Variations across Countries?
(Published 22-Dec-2008)”
This link takes you to the full PDF file of the document. It is interesting.
For primary care, most coutries get between $106k to $121K, US is $146K. Interestingly, the dreaded NHS of the UK is the $121, and France is a low outlier at only $84K! But keep looking through the graphs, they are interesting. For example, US PCP’s are payed 3.4 times the average wage of our countrymen, and this is in line with the top half dozen countries or so.
Turns out the Netherlands has physician income for specialists higher than ours, by quite a bit ($290K vs $236K). But the rest of the countries fall off fairly quickly. They do not have the large disparity of specialist vs PCP income that we do.
I don’t have the data (nor the skills!) to do the analysis, but I would be very interested in how wealth accumulation differs among the countries. Considering the large expense of American colleges and Medical Schools, I would make a guess that we are so far behind the eight ball when we finish our educations and training, that we probably don’t catch up with our international peers until we’re in our forties or fifties, except for the highly payed specialties.
So, would it be wiser to do as other countries do and heavily subsidize our educations so there is not so much pent up delayed gratification? And would that also lead to more PCPs and less income disparity among specialties?
5 Podcasts on Healthcare Reform found at the University Channel Web Site
Access to Universal Health Care Pt 1: New Jersey (Podcasts/Podcasts)
…Daniel A. Notterman, MD, MA, Department of Molecular Biology, Princeton University UNIVERSAL HEALTH CARE IN NEW JERSEY – Senator Joseph Vitale, Senator and Chairman, Health, Human Servi…
Access to Universal Health Care Pt 2: Worldwide (Podcasts/Podcasts)
Pt 2 UNIVERSAL HEALTH CARE WORLDWIDE – Uwe Reinhardt, PhD, James Madison Professor of Political Economy, Princeton University – Maggie Mahar, PhD, Fellow, The Century Foundation –
Access to Universal Health Care Pt 3: Keynote (Podcasts/Podcasts)
Pt 3 LUNCHEON SPEAKER – Len Nichols, PhD, Director, Health Policy Program, New America Foundation
Access to Universal Health Care Pt 4: Statewide Efforts (Podcasts/Podcasts)
Pt 4 UNIVERSAL HEALTH CARE IN THE NATION – THE MASSACHUSETTS EXPERIENCE & OTHER STATEWIDE EFFORTS – Nancy Turnball, PhD, Associate Dean for Educational Policy, Harvard School of Pub
How the Next President Can Deliver on Healthcare Reform (Podcasts/Podcasts)
…ive Vice President for Policy, AARP; Robert Moffit, Senior Fellow, Heritage Foundation; Joanne Silberner, Health Policy Correspondent, National Public Radio (Sep 26, 2008 at the National Pr…
For this last one, I highly recommend watching the Video so you can see Uwe Reinhardt’s slides.
I will give them a listen soon, but didn’t want to lose the links…
“This position paper concerns improving health care in the United States. Unlike previous highly focused policy papers by the American College of Physicians, this article takes a comprehensive approach to improving access, quality, and efficiency of care. The first part describes health care in the United States. The second compares it with health care in other countries. The concluding section proposes lessons that the United States can learn from these countries and recommendations for achieving a high-performance health care system in the United States. The articles are based on a position paper developed by the American College of Physicians’ Health and Public Policy Committee. This policy paper (not included in this article) also provides a detailed analysis of health care systems in 12 other industrialized countries.
Although we can learn much from other health systems, the College recognizes that our political and social culture, demographics, and form of government will shape any solution for the United States. This caution notwithstanding, we have identified several approaches that have worked well for countries like ours and could probably be adapted to the unique circumstances in the United States.”
Insure The Uninsured Project : Recent Reports
Health Care Systems Around the World
(November 2008)
Now I’m embarrassed. I just posted my summaries of the OECD summaries and get this in my inbox. Somebody who knows what they’re doing spent some real time investigating and writing about 10 systems from around the world. I haven’t read it yet, but wanted to get it up here, along with the one below:
The Healthy Americans Act (S. 334)
(October 2008)”
Cheers,
Summaries of summaries of healthcare systems based on the Commonwealth Fund reports.
Author(s) of the originals are:
Karsten Vrangbaek, Isabelle Durand-Zaleski, Reinhard Busse, Niek Klazinga, Sean Boyle, and Anders Anell
UK/NHS
• The UK, along with Sweden, is a prototypical socialized system.
• Essentially everyone is covered and all the funding takes place through a federal government taxes.
• General taxes account for 76% of the funding and then there are national insurance contributions to account for 19% of the funding. (I do not understand what the national insurance contributions are or where this money comes from.)
• User charges also account for a further 5% of the funding.
• Cost-sharing amounts to small drug co-pays of $14 but this is only for about 12% of all prescriptions written so it is therefore relatively small amount. In other words 80% of prescriptions require no co-pay.
• Dental requires up to $400 per year out of pocket before reimbursement occurs (I think).
• Out-of-pocket expenses account for 12% of the total health care expenditure.
• Primary care physicians are paid directly by the primary care trusts through capitation, salary, and fee-for-service arrangements.
• Hospitals are run by national health service trusts.
• Consultants and specialists are salaried.
• The private system in Britain covers approximately 12% of the population. It is a mix of profit and not-for-profit providers as well as supplementary insurance.
Summaries of summaries of healthcare systems based on the Commonwealth Fund reports.
Author(s) of the originals are:
Karsten Vrangbaek, Isabelle Durand-Zaleski, Reinhard Busse, Niek Klazinga, Sean Boyle, and Anders Anell
Germany
• Germany’s system is based on public or social health insurance (SHI)
• SHI is mandatory for those with income less than €48,000 (this is about 75 to 80% of the population)
• The top quintile of income earners can opt in or out of SHI; 75% of these high earners opt in. (This matches up interestingly with the quintiles in the US, with the top 5% in Germany opting out of SHI it sounds like.)
• Also civil servants and the self-employed are excluded from SHI and make up the bulk of the 10% of privately insured individuals. (I don’t understand the rationale of excluding the self-employed or, for that matter, civil servants except that I presume they just get these benefits paid for by the government anyway.)
• SHI covers the usual healthcare plus dental and drugs and more.
• Cost-sharing occurs through co-pays for outpatient visits, drugs and dental care. Apparently this is new since 2004. Cost-sharing max-out is 2% of income. Out-of-pocket expenses account for 13.8% of total health expenditure.
• SHI is operated by over 200 competing health insurers and these are called “Sickness Funds”.
• The Sickness Funds are all autonomous and nonprofit but regulated.
• Funding comes from the employer at 8% of gross up to €43,000 and from the employee at 7% of gross.
• For those not in SHI, the sickness funds set rates but in 2009 the government will collect and regulate this as well. After 2009 the government will distribute to sickness funds based upon risk adjustment mix of their clients.
• Interestingly, private health insurance rates cannot change once you have been accepted into the plan.
• Private health insurance accounts for less than 10% of the total health expenditure of Germany.
• Physicians receive fee for service plus “fees per time period” (the latter sounds like capitation). Just a note here to refer to the NPR story about the fee-for-service money running out towards the end of every quarter
• Hospital-based physicians are salaried.
• Hospitals are split up into about 1/2 public, 1/3 private nonprofit and 1/6 private for-profit. The latter for-profit segment is apparently growing at this time.
• Hospital reimbursement is now a DRG based.