Notes

Outline

National Health System Trends and Prospects for Care in the Delta Len M. Nichols Center for Studying Health System Change

About HSC Objective research on changes in the organization and delivery of care – and their impact on people Funded by The Robert Wood Johnson Foundation, affiliated with Mathematica Policy Research Emphasis on market dynamics Combination of data collection and research strategies www.hschange.org

The CTS Sites

Overview Trends in Health Care System National Policy Options Profile of DHEP States’ needs and workforce resources Policy Options for Delta states

Major Trends in the Health System Return of cost growth Little reduction in uninsured in strong economy Capacity constraints popping up Evaporation of surplus + no shared vision

The Cost Monster

What’s Driving Cost Growth Now? Provider push-back Prescription drugs Managed Care Loosening (Long Run = Technology)

Managed Care I, II, and THE END? Managed Care I: Early Blue Shield Staff HMOs Managed Care II: Medical Groups and IPAs PPOs POSs The Backlash Patient Protection The Failure -- Cost Growth Returns* The End, or a New Form? will we give up on   accountability? will we ever accept  cost-quality tradeoffs?

How Employers Might Respond Compete for labor, most of whom expect ESI Encourage federal subsidies of the non-group market to permit dropping out of ESI provision altogether Impose more employee cost-sharing Premium payments linked to provider choices Less generous coverage More cost-sharing at point of service Reduced benefits Choice of provider and degree of cost-sharing risk Quality/accountability initiatives

Major Trends in the Health System Return of cost growth Little reduction in uninsured in strong economy

Uninsurance and Unemployment Rates

Own vs. Dependent Coverage

Health Insurance Percentages

Major Trends in the Health System Return of cost growth Little reduction in uninsured in strong economy Capacity constraints popping up

Evidence of capacity constraints Patients reporting more delays, unmet need Physicians working longer hours ER overflow, patient diversion Shortages of nurses and staffed hospital beds

Major Trends in the Health System Return of cost growth Little reduction in uninsured in strong economy Capacity constraints popping up Evaporation of surplus + no shared vision

Who Is Likely to Be Uninsured? Latino 31% Black 17% White 10% All Adults 16% All Children    9% Poor   32% Near Poor 25% 2-4*poverty 12% Above 4*poverty   6% South 17% West 16% NE 11% Midwest 10%

Percent Uninsured, by Race/Ethnicity

Some Facts About the 39 Million Uninsured

Policy Options Subsidize individuals for the non-group market Subsidize individuals for all private markets Expand Medicaid/SCHIP Subsidize firms Subsidize providers directly Federal only vs. Federal + State

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Health behavior and outcomes problems that are worse in the rural south than in other rural areas Smoking among men Physical inactivity Infant mortality Teenage-births Dental visits Homicide

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Lack of Health Insurance

SCHIP enrollment

Workers in firms that offer health insurance

Policy Options “Borrow” money Study comparative performance Why didn’t Delta death rates fall as much as US overall? How do other rural regions address infant mortality, male smoking, obesity, etc.? Are particular professional team compositions particularly effective? (e.g. why did AR score worse in BP/PAP rates?) Professional recruitment and retention Focus on birth, STDs, heart & cancer Use household surveys to assess perceptions of unmet need Is it insurance/cost? Is it travel time/cost?