Deirdre Farrell, Zohal Ghiaszada, Erin Greco, Shevaun Harris, and Nina Hicks Quinnipiac University HM 600 1
Deirdre Farrell, Zohal Ghiaszada, Erin Greco, Shevaun Harris, and Nina Hicks
Quinnipiac University HM 600
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Illustrates the growing issue facing the U.S. in terms of inadequate access to quality affordable health care for the uninsured and underinsured
Highlights the impact on the overall health care delivery system
Identifies potential health care models of success
Reviews solutions offered through the Patient Protection and Affordable Care Act
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49.9 million Americans lacked health insurance
Approximately 25 million individuals between the ages of 19 – 64 are underinsured
There is a strong correlation between access to health insurance coverage and better health outcomes
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Inadequate health care coverage disproportionately affects minorities:
20.8% of Among African Americans
30.7% of Hispanics
11.7% of Caucasians 9.8% of children Individuals with lower incomes are at a higher risk
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Erosion of Private Health Coverage
Intermittent Gaps in Coverage
Lack of Affordability of Health Insurance
Other Barriers◦ Lack of knowledge
about other available resources
◦ Inability to pay out◦ of-pocket expenses◦ Childcare◦ Difficulty taking time
off from work◦ Transportation◦ Past Experiences
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Lack of preventative health care
Delayed follow-up treatment
Increased risk for hospitalization
Higher levels of ER usage
Higher rates of medical morbidity
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Medicaid is an entitlement program for the poor and disabled◦ Categorical eligibility requirements◦ Income eligibility requirements◦ Residency requirements◦ Citizenship status requirements
State Children’s Health Insurance Program (SCHIP)◦ Covers children who are ineligible for Medicaid
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48.6 million individuals are covered by Medicaid
Over $300 billion spent on the Medicaid program
Limited coverage for non-disabled adults under the age of 65 without dependent children
States can impose more restrictive eligibility requirements and benefit coverage
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Increase in national health expenditures◦$2.5 trillion spent in 2009 (4% increase)
The uninsured pay $30 billion in out of pocket expenses
$56 billion in uncompensated care $122 billion more needed to cover
uninsured
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Solutions and Challenges
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“It is vital that health reform reduces costs to make health care affordable; protects a patient's choice of doctors, hospitals,
and insurance plans; invests in prevention and wellness; and assures quality, affordable health care for all Americans.”
(Halle, Lewis, & Seshamani, 2009)
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Managing the high prevalence of chronic diseases
Improving access to care
Preventing the lack of routine care
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STRENGTHS CHALLENGES
Decrease health care costs
Develop an advisory group
Funding for chronic disease prevention and management
Incentives for Medicaid enrollees
Prevent denial because of pre-existing conditions
Need individual incentives for people to lose weight
Need to pay doctors and hospitals differently to compensate for time and effort on prevention
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STRENGTHS CHALLENGES
Provides affordable options for purchasing health coverage
Extends dependent health insurance coverage until the age of 26
Expands Medicaid eligibility requirements
Increase funding to train more doctors
Increase access to quality care
Shortage of primary care physicians ◦ Project shortage of 63,000
doctors in 2015
◦ Need at least 15% more medical students than projected 7,000 from the increased funding
Longer wait times to see doctor
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STRENGTHS CHALLENGES
Creation of the Prevention and Public Health Fund
Investment in tobacco cessation programs
Increase funding for prevention and screening programs
Eliminates co-payments, co-insurance, or deductibles for preventative services
Longer wait times to get an appointment
Physician shortages Increase usage of the
emergency room Increase in preventable
deaths as a result of reduced physician access
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Veterans Health Administration
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Model for low-cost and high-quality healthcare since the mid-1990s
Nation’s largest integrated health care system
1,400 sites 152 medical
centers
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Provides a full array of preventative services
53,000 independent licensed health care practitioners
83 million veterans served each year Priority group enrollment Co-payment exemptions
◦ Purple Heart Recipient◦ Prisoner of War◦ Service-Connect Injury
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Dr. Kenneth Kizer, former undersecretary of the Veterans Administration (VA)
Transformed the VA health system under his leadership in the mid-1990s◦ Outpatient focused care◦ Decentralization◦ System-wide computer network ◦ Patient centered approach
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As a government entity, the VHA cannot be sued for malpractice
Focus on preventative medicine Electronic records system Lower overhead and administrative costs
Higher customer satisfaction index than private institutions
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France and Italy
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First major study of the world’s healthcare systems in 2000
Evaluated on 5 criteria:◦ Overall level of the population’s health ◦ Health inequalities within the population ◦ Overall level of the health system’s
responsiveness ◦ Distribution of responsiveness within the
population ◦ Distribution of financing the systems between
economic classes in each population
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1st Place – France
2nd Place – Italy
37th Place – United States
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Hybrid of socialized and competitive systems Universal coverage– no uninsured The sicker you are, the less you pay
◦ Full reimbursement for treatment, drugs, surgeries, and procedures for chronic illnesses.
10-11% of Gross Domestic Product 21% of income is paid to the national healthcare
system◦ Employers pay between 11-13%
Supplemental coverage
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Highest satisfaction levels in Europe Average Life expectancy – 80.5 years
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“There are no uninsured in France. That's completely unheard of. There is no case of
anybody going broke over their health costs. In fact, the system is so designed that for the 3 or 4
or 5 percent of the patients who are the very sickest, those patients are exempt from their co-
payments to begin with. There are no deductibles.”
-- Victor Rodwin
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Servizio Sanitario Nazionale (SSN) Mandatory universal healthcare coverage
◦ No uninsured◦ All essential healthcare services
Autonomous regions Low satisfaction rate
◦ Quality issues◦ Waiting lists
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Can potentially decrease quality Competition between public and private
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eReferral and eConsult
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Demand >> Supply
Onerous and unreliable referral system
Lack of equitable triage
Poor communication between specialists and primary care providers (PCP)
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Patients Experiencing Problems Obtaining Specialty Care:
◦ Uninsured – 80% - 90%◦ Medicaid and Medicare- 40% - 50%◦ Private Insurances – 5 – 10%
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Handwrite/fax the referral form Loss of referral documentations No centralized method to track
the referrals Reason for consultation (include
pertinent history, physical laboratory findings, medications)
Proven model in safety-net facilities serving the uninsured
Enhance efficiency and improve communication between specialists and PCPs
Improve triage of referrals Goals
◦ Reduce demand◦ Increase efficiency◦ Improve quality◦ Enhance timely access
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BENEFITS NEXT STEPS
Health◦ Reduces mortality and
morbidity
Economical◦ Cuts down healthcare
expenses
Social◦ Reduced inequities and
disparities
Spread to other departments◦ Radiology (MRI, CT,
U/S) Build relationship
and trust◦ Other specialists
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National healthcare reform is already showing some success with the uninsured and underinsured
Successful Models for Addressing the Issue:◦ Veterans Healthcare Administration
Key Elements in Any Approach◦ Must focus on quality◦ Patient centered◦ Builds upon partnerships
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