Introduction to Healthcare and Public Health in the US

1. Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 1) Lecture b This material (Comp1_Unit4b) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number [IU24OC000015)].

2. Financing Healthcare (Part 1)Learning Objectives • Understand the importance of the healthcare industry in the US economy and the role of financial management in healthcare.  (Lecture b) • Describe models of health care financing in the US and in selected other countries. (Lecture c) • Describe the history and role of the health insurance industry in financing healthcare in the United States, and Federal laws that have influenced the development of the industry. (Lecture a) • Understand the differences among various types of private health insurance and describe the organization and structure of network-based managed care health insurance programs. (Lecture d) • Understand the various roles played by government as policy maker, payer, provider, and regulator of healthcare. (Lecture d) • Describe the organization and function of Medicare and Medicaid. (Lecture e) Introduction to Healthcare and Public Health in the US Financing Healthcare Lecture b

3. Lecture b Goals • Health care spending • Economic impact and gross domestic product • Health care jobs • The History of the US Health Insurance Industry • Historic legislation and factors contributing to the current US system of insurance • Roles of government in health care • Privately funded health care • Publically funded health care • Role Important federal laws Introduction to Healthcare and Public Health in the US Financing Healthcare Lecture b

4. Healthcare Financing & Expenditures • Healthcare financing • the collection and pooling of funds used to pay for healthcare services provided by a healthcare system, and • a mechanism of payment for these services • Healthcare expenditures • represent the total value of the healthcare services delivered by the healthcare system in a time period • Methods for examining spending include: • Category of Service • Contributor • Payer Introduction to Healthcare and Public Health in the US Financing Healthcare Lecture b

5. The US Healthcare Industry US Healthcare • Fifth largest sector of the economy by sales • 14.3 million employees • More than any other sector • 10 of 20 fastest growing occupations • 3.2 million new jobs by 2018 Introduction to Healthcare and Public Health in the US Financing Healthcare Lecture b

6. Healthcare and the EconomyNational Healthcare Spending 2009 • Gross Domestic Product (GDP): $14.25T • National Health Spending: $2.5T • as percentage GDP: 17.6% • projected spending %GDP (2019): 19.6% • U.S. Population (Millions): 305M • U.S. Per Capita Healthcare Costs: $8086 Introduction to Healthcare and Public Health in the US Financing Healthcare Lecture b

7. National Health Expenditures and Their Share of Gross Domestic Product, 1960-2009 5.2% 7.2% 9.2% 12.5% 13.8% 14.5% 15.4% 15.9% 16.0% 16.0% 16.1% 16.2% 16.6% 17.6% 4.1 Chart: Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; NHE summary including share of GDP, CY 1960-2009; file nhegdp09.zip). (CMS, 2011, PD-US, CC BY-NC-SA 3.0) Introduction to Healthcare and Public Health in the US Financing Healthcare Lecture b

8. National Health Expenditures per Capita, Select Years 1960-2009 4.2 Chart: The Kaiser Family Foundation, Kaiser Fast Facts. Data Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; NHE summary including share of GDP, CY 1960-2009; file nhegdp09.zip). Available at http://facts.kff.org/chart.aspx?ch=854. (KFF, CMS, 2011, PD-US, CC BY-NC-SA 3.0) . Introduction to Healthcare and Public Health in the US Financing Healthcare Lecture b

9. Total Health Expenditure per Capita, Select Countries, 2008 4.3 Chart: The Kaiser Family Foundation, Kaiser Fast Facts. Data Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database).doi: 10.1787/data-00350-en(Accessed on 14 February 2011). Available at http://facts.kff.org/chart.aspx?ch=1952. (KFF, CMS, 2011, PD-US, CC BY-NC-SA 3.0) . Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted. Introduction to Healthcare and Public Health in the US Financing Healthcare Lecture b

10. National Health Care Spending by Category of Service 2009 4.4 Table: Adapted from data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group. (CMS, nd., PD-US, CC BY-NC-SA 3.0). Introduction to Healthcare and Public Health in the US Financing Healthcare Lecture b

11. 2009 National Health Expenditures by Category (%) 4.5 Chart: 2009 National Health Expenditures by Category (%). Adapted from Centers for Medicare and Medicaid Services (CMS), Office of the Actuary . (CMS, nd., PD-US, CC BY-NC-SA 3.0). Introduction to Healthcare and Public Health in the US Financing Healthcare Lecture b

12. National Healthcare Expenditures Distribution by Contributor 2009 4.6 Chart : US Healthcare Expenditures by Contributor (2009). (CMS, CHCF, 2011, PD-US). Introduction to Healthcare and Public Health in the US Financing Healthcare Lecture b

13. US Healthcare Expenditures by Payer (2009) 4.7 Table: National Health Expenditures by Payer, 2009 . (CMS, nd., PD-US, CC BY-NC-SA 3.0) Introduction to Healthcare and Public Health in the US Financing Healthcare Lecture b

14. National Health Expenditures by Payer, 2009 4.8 Chart: US Healthcare Expenditures by Payer (2009). (CMS, CHCF, 2011, PD-US). Introduction to Healthcare and Public Health in the US Financing Healthcare Lecture b

15. Financing Healthcare (Part 1) Summary – Lecture b • US Healthcare and the Economy • Highest healthcare costs in the world • Healthcare cost represent almost one-fifth of GDP • Healthcare jobs continue to grow • Spending on services may be examined by • Category of service • Source of contributions used to pay for services • The insurance payer or plan Introduction to Healthcare and Public Health in the US Financing Healthcare Lecture b

16. Financing Healthcare (Part 1)References – Lecture b References Centers for Medicare and Medicaid Services. National health expenditure data, Table 1: National health expenditures aggregate, per capita amounts, percent distribution, and average annual percent growth, by source of funds—selected calendar years 1960–2009. https://www.cms.gov/NationalHealthExpendData/25_NHE_Fact_Sheet.asp . Updated January 13, 2011. Accessed April 13, 2011. StarkLaw.org. Stark law–information on penalties, legal practices, latest news and advice. http://www.starklaw.org. Accessed April 13, 2011. The Henry J Kaiser Family Foundation. U.S. health care costs explained. http://www.kaiseredu.org/Issue-Modules/US-Health-Care-Costs/Background-Brief.aspx. Updated March 2010. Accessed April 5, 2011. The Henry J Kaiser Family Foundation. Healthcare Costs: A Primer; available from: http://www.kff.org/insurance/ 7670.cfm Key information on health care costs. Last accessed March 22, 2011 The Henry J Kaiser Family Foundation. Menlo Park, CA: 2010 US Healthcare Costs; available from: http://www.kaiseredu.org/index.asp Provides background information, links to key data and policy information on US healthcare costs. Last accessed March 22, 2011 Introduction to Healthcare and Public Health in the US Financing Healthcare Lecture b

17. Financing Healthcare (Part 1)References - Lecture b (continued) Charts, Tables, Figures 4.1 Chart: The Kaiser Family Foundation, Kaiser Fast Facts. Data source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; NHE summary including share of GDP, CY 1960-2009; file nhegdp09.zip). Accessed 11 Dec 2011. (CMS, 2011, PD-US, CC BY-NC-SA 3.0). 4.2 Chart: The Kaiser Family Foundation, Kaiser Fast Facts. Data Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; NHE summary including share of GDP, CY 1960-2009; file nhegdp09.zip). Accessed 11 Dec 2011. Available at http://facts.kff.org/chart.aspx?ch=854. (KFF, CMS, 2011, PD-US, CC BY-NC-SA 3.0). 4.3 Chart: The Kaiser Family Foundation, Kaiser Fast Facts. Data Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en. Accessed on 11 Dec 2011. Available at http://facts.kff.org/chart.aspx?ch=1952. (KFF, CMS, 2011, PD-US, CC BY-NC-SA 3.0). Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted. 4.4 Table: Adapted from the National Health Care Spending by Category of Service 2009. Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/. Accessed on 11 Dec 2011. (see Historical; NHE summary including share of GDP, CY 1960-2009; file nhegdp09.zip). (CMS, nd., PD-US, CC BY-NC-SA 3.0). 4.5 Chart: 2009 National Health Expenditures by Category (%) Adapted from data source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ Accessed Dec 11, 2011. (see Historical; NHE summary including share of GDP, CY 1960-2009; file nhegdp09.zip). (CMS, nd., PD-US, CC BY-NC-SA 3.0). Introduction to Healthcare and Public Health in the US Financing Healthcare Lecture b

18. Financing Healthcare (Part 1)References - Lecture b (continued) Charts, Tables, Figures 4.6 Chart: National Healthcare Expenditures Distribution by Contributor (2009), Data Source: Centers for Medicare and Medicaid Services (CMS), Office of the Actuary. Retrieved 11 Dec 2011 from: http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/H/PDF%20HealthCareCosts11.pdf. (CMS, CHCF, 2011, PD-US). 4.7 Table: National Health Expenditures by Payer, 2009 Data source: http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; NHE summary including share of GDP, CY 1960-2009; file nhegdp09.zip). Accessed December 11, 2011 from: https://www.cms.gov/NationalHealthExpendData/25_NHE_Fact_Sheet.asp. 4.8 Chart: US Healthcare Expenditures by Payer. CMS, CHCF(2009). Data Source: Centers for Medicare and Medicaid Services (CMS), Office of the Actuary. https://www.cms.gov/NationalHealthExpendData/25_NHE_Fact_Sheet.asp. Retrieved Jan 2012 from: www.chcf.org/~/media/.../PDF/H/PDF%20HealthCareCosts11.pdf. (CMS, CHCF, 2011, PD-US). Introduction to Healthcare and Public Health in the US Financing Healthcare Lecture b