excerpts from an informative study..click the link in the title to access the full study...rw
There are both indicators of health (outcome measures) and determinants of health. Mortality data - life expectancy, standardized mortality, infant mortality, maternal mortality and years of potential life lost - have been the main measures of the health status of a population. As life expectancy and the prevalence of chronic disease has been increasing, there has been a need for other indicators that measure the quality of life; indicators that measure self-perceived health, physical disability, mental functioning, etc.47
The decision of how to rank country performance is based on the paradigm of what should constitute a health-care system's principles when trying to achieve better health status for a population: high quality care, broad access to care and low costs.
Quality of care is measured using the categories of health status, mortality rates, preventable illnesses, appropriateness of services and patient satisfaction. Access to care takes into account the amount of insurance coverage in a population, equity in health outcomes, how health spending is distributed between acute and other health services, the availability of medical expertise and technology. Cost comprises efficiency, total health spending and sustainability.
...Singapore has the "best" health-care system of the eight countries, with a score of 62.1. In terms of the overall health-system score, the United Kingdom ranks second (60.5), Switzerland third (59.2), followed by Germany (59.0), Australia (56.8), Canada (56.7), the United States (53.6) and South Africa (45.4).
Quality of care
The health of a population is due, in part, to the quality of a country's health-care system. The safe birth of a child, the public's awareness of what constitutes healthy eating and living, and the incidence of treatable diseases all relate to how well a health system is performing.
Canada ranks first in health status. This category includes life expectancy, healthy life expectancy (years lived free-of-disability), the percent of population not expected to survive to age 40, self-reported health status, and the prevalence of smoking, alcohol consumption and obesity in the population. (My note: the US rates Fifth of eight, behind Switzerland, Canada, Singapore, and Germany in health status indicators. Tell me again how the US has the best healthcare system in the world? read on, we cant even claim the highest rating for Technology or satisfaction with all our options...)
Switzerland has the highest patient satisfaction, due to short waiting times for non-emergency treatment and to a high system-responsiveness ranking ...
Access to care
In Switzerland, health insurance is mandatory and, in Canada, the United Kingdom and Australia, every citizen is eligible for health insurance provided by the public sector. These countries, therefore, rank highly in terms of health coverage.
With respect to the availability of health-care resources, Germany ranks first, scoring 76.6 for service availability. Germany has more hospital beds per capita, and more physicians, specialists and dentists per 1,000 population than any of the other countries. While Switzerland does not have the most computed tomography (CT) scans per million people or the most magnetic resonance imagers (MRIs) per million population - it comes second to Australia in CT scans and second to the United States with respect to MRIs - it manages to attain the top ranking in the technology category with a score of 88.3.
Cost Of Care
While there is some debate as to whether high health-care spending is positive or negative, the traditional perspective is that health costs must be contained. Therefore, this study assumes that more spending on health is worse than less. Thus, both Singapore (94.7) and South Africa (87.4) rank highly while the United States scores the lowest on every indicator and receives a score of zero for this category. Germany, another big spender on health, scores a 34.6.
The sustainability of a health-care system is dependent on whether a country can afford to maintain it. The aging population is going to put a stress on every health-care system, thus the projected percent of the population over 65 years old and the amount spent on them relative to the rest of the population are included in this category. Sustainability also includes the number of medical students per million population, total expenditure on research and development (R&D), and the number of R&D scientists and technicians per 1,000 population.
Switzerland, with a score of 54.9, is in the most favorable position regarding the future of its health-care system; the United States and Australia, both at 35.7, the worst.
WHO's report ... that there is evidence that health systems do little to improve health: studies have shown life expectancy to be correlated with income per capita but not to the numbers of doctors, hospital beds or health expenditure.
As well, in the United States alone, medical errors kill some 44,000 people in hospitals annually.50 And, WHO notes that, while "rich" people tend to benefit more from the use of hospital and primary care services, "the distribution of primary care is almost always more beneficial to the poor than hospital care…."51
As with most studies of this nature, the main conclusion is that more data and a higher quality of data are needed. Areas for which data are lacking include the numbers and types of hospital procedures being performed; who is being treated, for what and how promptly;
The list is almost endless.
A well-defined set of performance indicators would help policymakers, funders and health managers in the management of health-care systems and policy development. It would help patients better monitor the quality of the system into which their tax dollars are going and from which they must receive their health care.
Tuesday, December 20, 2005
Health Care for All, Just a (Big) Step Away
December 18, 2005
Economic View
By EDUARDO PORTER
"I don't think anybody would dispute the economics," Mr. Gruber said. "I think the dispute would be over the politics."
YOU may find it shameful that some 45 million Americans lack health insurance. Well, by reallocating money already devoted to health insurance, the government could go along way toward solving the problem. But you may not like the solution.Next year, the federal government expects to provide about $130 billion for Americans to buy health insurance. The amount is substantial: it is equivalent to about 11 percent of all federal income tax revenue and more than a fifth of federal spending on Medicare and Medicaid. And it is growing fast: the bill is expected to surpass $180 billion in 2010.
Although subsidizing health insurance may seem a worthy effort, a positive contribution to the goal of universal coverage, it is among the most inefficient spending in the nation's fiscal arsenal."If you had $150 billion to play with, you could come very close to universal coverage," said David Cutler, an economics professor at Harvard. One reason that we are 45 million people short of that goal is that the money isn't being spent on them.According to President Bush's advisory panel on tax reform, about half of the tax break for health insurance accrues to families making more than $75,000 a year. More than a quarter goes to families making over $100,000.
Still, the fiscal incentive isn't helping many of the people who need it most. A report by the Kaiser Family Foundation says two-thirds of the 45.5 million Americans who lacked health insurance in 2004 earned less than twice what the federal government defines as poverty. (For a family of four, the poverty line is about $19,300.) In four of every five cases, the uninsured made less than three times the poverty level.In addition to going to the wrong people, the subsidy as designed promotes wasteful medical spending, encouraging the wealthy to buy more insurance and to use more health services than they need, according to the president's tax panel. And it may bolster premiums across the board.
As part of a series of proposals to rejigger the tax code, the president's tax panel issued a report earlier this year that suggested capping the total that can be paid in pretax dollars at an amount equal to the average health insurance premium in the country: some $11,500 for a family.But if the objective is to expand health care coverage, a bolder option is available: focusing the bulk of the money on the bottom end of the income distribution.Added to what is already spent on Medicaid, this financing would be roughly enough to make health insurance free for people earning up to three times the poverty level, and perhaps somewhat more, said Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology who has studied the efficiency of alternative methods for financing health insurance.
The government could give tightly focused tax credits so that lower-income people could buy health insurance on the market. And it could organize pools by, say, requiring insurers to charge the same for similar policies sold to people of the same age group who live in the same area.Regina E. Herzlinger, a professor of business administration at Harvard Business School, notes that the Swiss have such a system: privately provided health insurance priced by age and residence and subsidized at low incomes. This, she said, gives the Swiss top-notch health services, universal health insurance and a medical bill that tops out at 10 percent of the nation's output, compared with 15 percent in the United States.
SOME of these ideas are beginning to gain traction in America, too. Massachusetts is considering a law that would make health insurance mandatory. It would expand Medicaid to cover families in the state that make less than twice the poverty level and offer tax credits on a sliding scale up to four times the poverty line. It would also provide for creation of insurance pools for people who don't get coverage through employers.This health care revolution, however, is unlikely to catch on nationally anytime soon. For starters, losing the tax break on employer-provided health insurance would be tremendously disruptive for the millions of Americans who get their insurance through their jobs. Perhaps most important, it would force higher-income families to buy health care without the tax break; that idea is probably as politically suicidal as abolishing the mortgage tax deduction."I don't think anybody would dispute the economics," Mr. Gruber said. "I think the dispute would be over the politics."
Economic View
By EDUARDO PORTER
"I don't think anybody would dispute the economics," Mr. Gruber said. "I think the dispute would be over the politics."
YOU may find it shameful that some 45 million Americans lack health insurance. Well, by reallocating money already devoted to health insurance, the government could go along way toward solving the problem. But you may not like the solution.Next year, the federal government expects to provide about $130 billion for Americans to buy health insurance. The amount is substantial: it is equivalent to about 11 percent of all federal income tax revenue and more than a fifth of federal spending on Medicare and Medicaid. And it is growing fast: the bill is expected to surpass $180 billion in 2010.
Although subsidizing health insurance may seem a worthy effort, a positive contribution to the goal of universal coverage, it is among the most inefficient spending in the nation's fiscal arsenal."If you had $150 billion to play with, you could come very close to universal coverage," said David Cutler, an economics professor at Harvard. One reason that we are 45 million people short of that goal is that the money isn't being spent on them.According to President Bush's advisory panel on tax reform, about half of the tax break for health insurance accrues to families making more than $75,000 a year. More than a quarter goes to families making over $100,000.
Still, the fiscal incentive isn't helping many of the people who need it most. A report by the Kaiser Family Foundation says two-thirds of the 45.5 million Americans who lacked health insurance in 2004 earned less than twice what the federal government defines as poverty. (For a family of four, the poverty line is about $19,300.) In four of every five cases, the uninsured made less than three times the poverty level.In addition to going to the wrong people, the subsidy as designed promotes wasteful medical spending, encouraging the wealthy to buy more insurance and to use more health services than they need, according to the president's tax panel. And it may bolster premiums across the board.
As part of a series of proposals to rejigger the tax code, the president's tax panel issued a report earlier this year that suggested capping the total that can be paid in pretax dollars at an amount equal to the average health insurance premium in the country: some $11,500 for a family.But if the objective is to expand health care coverage, a bolder option is available: focusing the bulk of the money on the bottom end of the income distribution.Added to what is already spent on Medicaid, this financing would be roughly enough to make health insurance free for people earning up to three times the poverty level, and perhaps somewhat more, said Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology who has studied the efficiency of alternative methods for financing health insurance.
The government could give tightly focused tax credits so that lower-income people could buy health insurance on the market. And it could organize pools by, say, requiring insurers to charge the same for similar policies sold to people of the same age group who live in the same area.Regina E. Herzlinger, a professor of business administration at Harvard Business School, notes that the Swiss have such a system: privately provided health insurance priced by age and residence and subsidized at low incomes. This, she said, gives the Swiss top-notch health services, universal health insurance and a medical bill that tops out at 10 percent of the nation's output, compared with 15 percent in the United States.
SOME of these ideas are beginning to gain traction in America, too. Massachusetts is considering a law that would make health insurance mandatory. It would expand Medicaid to cover families in the state that make less than twice the poverty level and offer tax credits on a sliding scale up to four times the poverty line. It would also provide for creation of insurance pools for people who don't get coverage through employers.This health care revolution, however, is unlikely to catch on nationally anytime soon. For starters, losing the tax break on employer-provided health insurance would be tremendously disruptive for the millions of Americans who get their insurance through their jobs. Perhaps most important, it would force higher-income families to buy health care without the tax break; that idea is probably as politically suicidal as abolishing the mortgage tax deduction."I don't think anybody would dispute the economics," Mr. Gruber said. "I think the dispute would be over the politics."
Wednesday, December 14, 2005
EBRI Report of SurveyFindings
Employee Benefit Research Institute
December 2005
Early Experience With High-Deductible and Consumer-Driven Health Plans:
Findings From the EBRI/ Commonwealth Fund Consumerism in Health Care Survey
By Paul Fronstin, EBRI, and Sara R. Collins, The Commonwealth Fund ...
The sample was randomly drawn from Harris Poll Online...The final sample of adults participating in the survey is skewed toward higher-income, more highly educated individuals and also under represents minorities. Despite its limitations, this is the first national survey of individuals with high-deductible health plans who also have savings accounts (HSAs or HRAs), or so-called consumer-driven health plans (CDHPs), and people with high-deductible health plans who are eligible to contribute to a health savings account but who currently do not have an account (HDHP).
...When combined with premiums, outlays on health care as a share of income rose substantially among those with HDHPs and CDHPs, particularly among those with low incomes or health problems. More than two-fifths (42 percent) of people with HDHPs and 31 percent of those in CDHPs spent 5 percent or more of their income on out-of-pocket costs and premiums, compared with 12 percent of people in comprehensive plans. Nearly everyone (92 percent) with HDHPs with incomes under $50,000 spent 5 percent or more of their income on out-of-pocket costs and premiums, and one-third spent 10 percent or more. This compares with 34 percent of people in that income group in comprehensive plans...
While people reported using health services at similar rates across health plans, adults with CDHPs and HDHPs were significantly more likely to report that they had avoided, skipped, or delayed health care because of costs than were those with comprehensive insurance...
About one-third of people in CDHPs (35 percent) and HDHPs (31 percent) reported delaying or avoiding care, twice the rate of those in comprehensive health plans (17 percent)...
....the survey...demonstrates that cost-related reductions in demand are highest among individuals with the most to lose-those who are sick and those who have low incomes. To the extent that the health care cost problem is a problem owned by all of us, early evidence from the consumerism movement suggests that solving it through blunt, demand-side instruments like high deductibles gives disproportionate responsibility for the problem to the most vulnerable among us.
For the Full report @ http://www.ebri.org/pdf/briefspdf/EBRI_IB_12-2005.pdf
or click the Title of this post for the link.
Comment:
Although the negative impact of CDHPs and HDHPs were fully predicted and then confirmed by this survey, one finding is shocking in the intensity of the negative impact: "Nearly everyone (92 percent) with HDHPs with incomes under $50,000 spent 5 percent or more of their income on out-of-pocket costs and premiums, and one-third spent 10 percent or more." The introduction of financial disincentives to care resulted in widespread financial hardship. A fundamental principle of health care research is that when preliminary results demonstrate significant harm that cannot be offset by any potential benefit, it is an ethical imperative that the study be terminated immediately. The experiment with CDHP and HDHP has already crossed that threshold. Further experimentation can only define more precisely the enormity of financial hardships created. Health policy researchers have the same ethical obligation as biomedical researchers; they should call for an immediate end to this disastrous experiment. What feature of this model is causing the harm? The HSA plays an insignificant role in that it is merely a restricted savings account. The patient must still meet the out-of-pocket expenses whether they come from other income or savings or from this account distinguished primarily by an inequitable, regressive tax benefit. The real harm is caused by the high-deductible requirement of both the CDHPs and the HDHPs. Extensive data already exist that confirm the harm done by high deductibles in impairing access and health outcomes and in creating a financial burden for those in need. This study indicates that the financial hardship appears to be far more extensive than previously thought. What can we do? Existing HSAs can be converted into IRAs, and future HSAs should be prohibited as bad tax policy, bad pension policy and bad health policy. HDHPs should be prohibited. Financial hardship created by the need to access the health-care system can be eliminated by covering all beneficial services through a single risk pool. Since insurers will never attempt to corner the market on those who need care, this can be accomplished only by public policies requiring a universal pool. It's time for single payer.
Quote-of-the-day mailing list
Quote-of-the-day@mccanne.org
http://two.pairlist.net/mailman/listinfo/quote-of-the-day
December 2005
Early Experience With High-Deductible and Consumer-Driven Health Plans:
Findings From the EBRI/ Commonwealth Fund Consumerism in Health Care Survey
By Paul Fronstin, EBRI, and Sara R. Collins, The Commonwealth Fund ...
The sample was randomly drawn from Harris Poll Online...The final sample of adults participating in the survey is skewed toward higher-income, more highly educated individuals and also under represents minorities. Despite its limitations, this is the first national survey of individuals with high-deductible health plans who also have savings accounts (HSAs or HRAs), or so-called consumer-driven health plans (CDHPs), and people with high-deductible health plans who are eligible to contribute to a health savings account but who currently do not have an account (HDHP).
...When combined with premiums, outlays on health care as a share of income rose substantially among those with HDHPs and CDHPs, particularly among those with low incomes or health problems. More than two-fifths (42 percent) of people with HDHPs and 31 percent of those in CDHPs spent 5 percent or more of their income on out-of-pocket costs and premiums, compared with 12 percent of people in comprehensive plans. Nearly everyone (92 percent) with HDHPs with incomes under $50,000 spent 5 percent or more of their income on out-of-pocket costs and premiums, and one-third spent 10 percent or more. This compares with 34 percent of people in that income group in comprehensive plans...
While people reported using health services at similar rates across health plans, adults with CDHPs and HDHPs were significantly more likely to report that they had avoided, skipped, or delayed health care because of costs than were those with comprehensive insurance...
About one-third of people in CDHPs (35 percent) and HDHPs (31 percent) reported delaying or avoiding care, twice the rate of those in comprehensive health plans (17 percent)...
....the survey...demonstrates that cost-related reductions in demand are highest among individuals with the most to lose-those who are sick and those who have low incomes. To the extent that the health care cost problem is a problem owned by all of us, early evidence from the consumerism movement suggests that solving it through blunt, demand-side instruments like high deductibles gives disproportionate responsibility for the problem to the most vulnerable among us.
For the Full report @ http://www.ebri.org/pdf/briefspdf/EBRI_IB_12-2005.pdf
or click the Title of this post for the link.
Comment:
Although the negative impact of CDHPs and HDHPs were fully predicted and then confirmed by this survey, one finding is shocking in the intensity of the negative impact: "Nearly everyone (92 percent) with HDHPs with incomes under $50,000 spent 5 percent or more of their income on out-of-pocket costs and premiums, and one-third spent 10 percent or more." The introduction of financial disincentives to care resulted in widespread financial hardship. A fundamental principle of health care research is that when preliminary results demonstrate significant harm that cannot be offset by any potential benefit, it is an ethical imperative that the study be terminated immediately. The experiment with CDHP and HDHP has already crossed that threshold. Further experimentation can only define more precisely the enormity of financial hardships created. Health policy researchers have the same ethical obligation as biomedical researchers; they should call for an immediate end to this disastrous experiment. What feature of this model is causing the harm? The HSA plays an insignificant role in that it is merely a restricted savings account. The patient must still meet the out-of-pocket expenses whether they come from other income or savings or from this account distinguished primarily by an inequitable, regressive tax benefit. The real harm is caused by the high-deductible requirement of both the CDHPs and the HDHPs. Extensive data already exist that confirm the harm done by high deductibles in impairing access and health outcomes and in creating a financial burden for those in need. This study indicates that the financial hardship appears to be far more extensive than previously thought. What can we do? Existing HSAs can be converted into IRAs, and future HSAs should be prohibited as bad tax policy, bad pension policy and bad health policy. HDHPs should be prohibited. Financial hardship created by the need to access the health-care system can be eliminated by covering all beneficial services through a single risk pool. Since insurers will never attempt to corner the market on those who need care, this can be accomplished only by public policies requiring a universal pool. It's time for single payer.
Quote-of-the-day mailing list
Quote-of-the-day@mccanne.org
http://two.pairlist.net/mailman/listinfo/quote-of-the-day
Thursday, December 01, 2005
Lehrer News Hour/Plight of the Uninsured
This information comes thru Peggy @ FamiliesUSA
Click on the post title if you would like to access the segment from the mentioned FamiliesUSA website, or check them out thru my links on the right-rw
On Monday, November 28th, the NewsHour with Jim Lehrer carried a special segment on the plight of the uninsured. This very good segment will be of interest to all who missed it. One of the people interviewed was Anthony Wright of Health Access California...
So, if you missed the NewsHour segment, you can get the transcript and/or watch the video clip by going to the NewsHour site. We have also included a link to this on our Web site, in the Across the States page under "What's New in the States?"
Click on the post title if you would like to access the segment from the mentioned FamiliesUSA website, or check them out thru my links on the right-rw
On Monday, November 28th, the NewsHour with Jim Lehrer carried a special segment on the plight of the uninsured. This very good segment will be of interest to all who missed it. One of the people interviewed was Anthony Wright of Health Access California...
So, if you missed the NewsHour segment, you can get the transcript and/or watch the video clip by going to the NewsHour site. We have also included a link to this on our Web site, in the Across the States page under "What's New in the States?"
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