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The Employer based Health Care System IV

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					The Employer-based Health Care System:
       Shifting Responsibilities



         2007 National Health Policy Conference
              Eduardo Sanchez, M.D., M.P.H.
            Director, Institute for Health Policy
                 School of Public Health
  University of Texas Health Science Center at Houston
                     February 12, 2007
Employer-financed Health Care
     and the Uninsured
The Rising Spiral of Health-Care
            Costs
 – Healthcare premiums are growing more than 3
   times faster than workers’ wages and 2.5
   times faster than the inflation rate
 – Percentage of employers providing health
   benefits
   • 2000       69%
   • 2005       60%


 – State of Texas employee health care costs up
   53% since 2000

            2005 Kaiser Foundation Survey
     Employer-Sponsored
     Insurance Coverage
• 61% have insurance through their employer
  in the United States
• In Texas, only 53% have insurance through
  their employer


• 43% of companies with 50 or less
  employees provide insurance nationally
• In Texas, only 31% of companies with 50
  or less employees provide insurance

          Texas Hospital Association, April 2006
   Government-Sponsored
Insurance Coverage in Texas

• Medicaid
• CHIP
• County-based medical programs
• Health insurance for employees/retirees




         Texas Hospital Association, April 2006
    Spiral of Health Cost
       Increases with
 High Numbers of Uninsured
                     Uninsured utilize higher
                   than necessary levels of care


                                               Higher
       More uninsured                     uncompensated costs



More employers drop coverage              Increased charges
 because of high premiums                to paying customers


                      Insurance companies
                   Raise premiums for insured
       For More Information
 Task Force Website
http://www.utsystem.edu/hea
  /taskforce/homepage.htm


 Report Website
http://www.coderedtexas.org
How can the spiral be interrupted?


• Reduce the number of uninsured
  – Increase numbers of eligible and enrolled in
    Medicaid/CHIP/state or local government
    programs
  – Make insurance more accessible/affordable
    • Individually purchased
    • Employer provided
  – Necessary but not sufficient
    The Healthcare Equation is Out
              of Balance
                                        Supply
                        •   Increasing Access
         Demand         •   Increasing Workforce
•   Older               •   System Redesign
•   Heavier             •   Improving Quality of Care
•   More Sedentary      •   Improving Technology
                        •   Improving Meds
•   Un & Underinsured
•   Health Illiterate
 The Healthcare Equation is Out
           of Balance

                                                Supply
Health Promotion                •   Increasing Access
• Health literacy initiatives   •   Increasing Workforce
• Healthier lifestyles          •   System Redesign
• Access to care (clinical      •   Improving Quality of Care
   preventive services)         •   Improving Technology
                                •   Improving Meds


             Demand Reduction Is Imperative
How can the spiral be interrupted?


• Improve population health
  – Traditional and chronic disease-focused
    public health
  – School-based health education and
    management
  – Worker health promotion (worksite wellness)
How can the spiral be interrupted?


• Transform the health care delivery system
  – Invest in and connect to public health
  – Primary-care centered health system
                                                                          Concept
                        Primary-care Centered Health
                                  System


Public Health                             Medical Care
                           Primary Care                    Specialty/Tertiary Care

  Tobacco                                                         Specialty Care
 Prevention
                            Patient Centered
And Cessation
                             Medical Home                           Diagnostic
                        (mental/dental/medical)                       Testing
                     1. Easy access
Comprehensive        2. Continuity of care
 School Heath        3. Comprehensive care
                                                                  Hospital Based
  Education          4. Coordination of all care
                                                                      Care
                     (Includes disease management)
                                                                  Inpatient Care

 Worker and
  Worksite                                                       Emergency and
  Wellness                                                        trauma care

                = Optimal Communication (Integrated Virtual System)
                  Including best use of health informational technology
     Two questions to ponder
• Who pays and how?
  – Financing


• What are we buying?
  – Population health

				
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