Medizinische Soziologie. Das Gesundheitssystem II: USA und UK
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1 Vorlesung WS 2013 Medizinische Soziologie Das Gesundheitssystem II: USA und UK Thomas Kohlmann, Sandra Meyer-Moock & You-Shan Feng Institut für Community Medicine Universität Greifswald
2 Models of Health Systems Beveridge Model Bismarck Model National Health Insurance Out-of-pocket 2
3 General Characteristics Pop: 62,041,708 (2010 est) Size: 243,610 km 2 GDP: $35,720 (2009 Est) Parlimentary Pop: 310,872,000 (2010 est) Size: 9,826,675 km 2 GDP: $47,701 (2009 est) Federalist 3
4 International Comparison of Spending on Health, Average spending on health per capita ($US PPP) Total expenditures on health as percent of GDP United States Norway Switzerland Canada Netherlands Germany France Denmark Australia Sweden United Kingdom New Zealand United States France Switzerland Germany Canada Netherlands New Zealand Denmark Sweden United Kingdom Norway Australia Figures from The Commonwealth Fund Website. Source Data: OECD Health Data 2010 (June 2010): 4
5 Mortality Amenable to Health Care * Countries age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial infections. Analysis of World Health Organization mortality files and CDC mortality data for U.S. Deaths per 100,000 population* France Australia Italy Japan Sweden Norway Netherlands Source: Adapted from E. Nolte and M. McKee, Variations in Amenable Mortality Trends in 16 High Income Nations, Health Policy, published online Sept. 12, Austria 5 Finland Germany Greece Ireland New Zealand Denmark United Kingdom United States
6 Overview UK Health System Public System Equal access to the entire population living in the UK Centrally Regulated US Health System Hybrid System Market Based Disbursed Regulation Health and Social Care Care Act 2012 (27 March 2012) 2010 Patient Protection and Affordable Care Act (ACA, Obamacare ) 6
7 Brief History of the UK Health System 7
8 1911: Mixed Bag Trade Unions Friendly Societies Employers Etc. Private Insurances Providers 1948 (Post WWII): National Health Service Hospitals Budget Salary Specialists General Taxes Capitation GPs Gatekeeper Figures adapted from: Bodenheimer TS & Brumbach K. (2002). Understanding Health Policy: A Clinical Approach, Third Edition. The McGraw Hill Companies, Inc Medizinische Soziologie Vorlesung 2011/2012 8
9 1979, 1980s Conservatives: Introduces Internal Markets Strategic Health Authorities (SHA) Budget Buy Services Hospitals General Taxes Specialists Expanded Capitation GPs Buy Services Providers Purchasers Figures adapted from: Bodenheimer TS & Brumbach K. (2002). Understanding Health Policy: A Clinical Approach, Third Edition. The McGraw Hill Companies, Inc Medizinische Soziologie Vorlesung 2011/2012 9
10 1997, 2000s New Labour: Competition + Regulation Strategic Health Authorities (SHA) Secondary care General Taxes Fund and Manage Budget for Primary care Primary Care Trusts (PCT) Contract: Private Providers Figures adapted from: Bodenheimer TS & Brumbach K. (2002). Understanding Health Policy: A Clinical Approach, Third Edition. The McGraw Hill Companies, Inc Medizinische Soziologie Vorlesung 2011/
11 Inpatient waiting times, England, (months waited) Medizinische Soziologie Vorlesung 2012/
12 Health & Social Care Act 2012 the status quo is not an option 12
13 Any Qualified Provider , accessed Nov
14 Brief History of the US Health System(s) 14
15 Pre 1900s: Nearly no third party health plans Out of pocket Individual Provider Early 1900s: Private Insurance Health Plans Premium Reimbursement Individual Health Plan Provider Figures adapted from: Bodenheimer TS & Brumbach K. (2002). Understanding Health Policy: A Clinical Approach, Third Edition. The McGraw Hill Companies, Inc Medizinische Soziologie Vorlesung 2011/
16 World War II: Employer Sponsored Health Plans Premium Reimbursement Employee + Employer Health Plan Provider 1965 Medicare & Medicaid: Government Sponsored Health Plans Workers Individuals Taxes Enrollment (Premium) Public Plan Reimbursement Provider Figures adapted from: Bodenheimer TS & Brumbach K. (2002). Understanding Health Policy: A Clinical Approach, Third Edition. The McGraw Hill Companies, Inc Medizinische Soziologie Vorlesung 2011/
17 Health Insurance Coverage in the U.S., 2008 SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2009 CPS; figure from the Kaiser Family Foundation Website. Uninsured 16% Employer- Sponsored Insurance 49% Medicaid 16% Medicare 13% 1974: ERISA 1985: COBRA 1996: HIPPA Private Non-Group 5% Other Public 1% Total = million 17
18 Average Annual Worker and Employer Contributions to Premiums and Total Premiums for Family Coverage, * Estimate is statistically different from estimate for the previous year shown (p<.05). Source: Kaiser/HRET Survey of Employer Sponsored Health Benefits, Figure from Kaiser Family Foundation Website 1999 $5,791 $1,543 $4,247 Worker Contribution 2000 $1,619 $4,819* $6,438* Employer Contribution 2001 $1,787* $5,269* $7,061* 2002 $2,137* $5,866* $8,003* 2003 $2,412* $6,657* $9,068* 2004 $2,661* $7,289* $9,950* 2005 $2,713 $8,167* $10,880* 2006 $2,973* $8,508* $11,480* 2007 $3,281* $8,824 $12,106* 2008 $3,354 $9,325* $12,680* 2009 $3,515 $9,860* $13,375* 2010 $3,997* $9,773 $13,770* $0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 18
19 Decline in Employer Sponsored Health Insurance 19
20 Health Insurance Coverage in the U.S., 2008 SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2009 CPS; figure from the Kaiser Family Foundation Website. Uninsured 16% Employer- Sponsored Insurance 49% Medicaid 16% Medicare 13% Private Non-Group 5% Other Public 1% Total = million 20
21 Public Plans Medicare (1965) Federal Level for >65 years old and eligible for social security, those with severe disabilities and those with chronic renal disease Medicaid (1965) State Level Low income and disabled SCHIP (1997, reauthorized 2009) State Level Children in low income families Military/Veteran s Association (1930) Military and former military personnel 21
22 Chart 4.6: Aggregate Hospital Payment-to-cost Ratios for Private Payers, Medicare, and Medicaid, Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2008, for community hospitals. (1) Includes Medicaid Disproportionate Share payments. Figure from American Hospital Association s Trendwatch Chartbook
23 Health Insurance Coverage in the U.S., 2008 SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2009 CPS; figure from the Kaiser Family Foundation Website. Uninsured 16% Employer- Sponsored Insurance 49% Medicaid 16% Medicare 13% Private Non-Group 5% Other Public 1% Total = million 23
24 Total Number of Uninsured, Note: Figures for are U.S. residents without hospital insurance. Data: National Health Interview Survey, Current Population Survey, The Lewin Group. Figure Taken from Commonwealth Fund Website Millions uninsured
25 Medizinische Soziologie Vorlesung 2012/
26 Patient Protection and Affordable Care Act 2010 (111th congress) March 23, 2010: President Obama signed the bill into law Insure 32 million americans in the next 10 years $940 billion (Milliarden) 26
27 Protection Affordable Mandated health insurance for all residents Large employers must provide insurance for employees Expand Medicaid and CHIP Cannot discriminate for preexisting conditions Young adults can stay on parents plan New private insurance regulations Provide premiums for low income families Provide funds for health insurance for small businesses Create state-based Exchanges 27
28 Subsequent Actions "Repealing the Job-Killing Health Care Law Act" (H.R.2): (and 42 House votes to repeal) June 8, 2012: Supreme court upholds all but one provision of the ACA. *Created coverage gap* 28
29 29
30 ACA Exchangs Rollout: A first look 30
31 Thank you for your attention! 31
32 Health and Social Care Act 2012 Resturcturnig Medizinische Soziologie Vorlesung 2012/
33 Affordable Care Act Rollout
34 Some additional resources Informative, entertaining and free radio segments about the American health care system (created for lay audiences). Comparative Health Politics: The United States and the United Kingdom Journal of Health Politics, Policy and Law (Duke University Press) Special issue in Feb
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